Insurance FAQs
Will my compounded prescription be covered by my insurance?
We have yet to see a policy that does not cover compounded medications. For all of its intricacies or complexity, you still have simply had a prescription filled for a compounded medication, and under the terms of your policy, it should be covered. However, there can be restrictions in you benefits that may exclude a particular kind of compound. It is best to check your policy for this information. A phone call to your insurance carrier may not result in accurate information.

Why can't I use my prescription card for this prescription?
Use of a prescription card requires that a host of information about you, your prescription and your doctor is sent to the pharmacy benefits manager (PBM) selected by your insurance company. This happens each time a prescription is filled using your prescription card, and includes a National Drug Code (NDC) number for the medication -- the equivalent of a social security number unique to that medication.

However, only the food and Drug Administration can assign a NDC number to a medication. And this is only assigned to commercially manufactured medications -- the typical medications produced by drug companies that most people associate with filling a prescription.

Your unique medication, however, is custom-compounded in our laboratory specifically for you. It is exempt from the requirement of an NDC number, so no number exists for this purpose. Sometimes the chemicals used will have a fictitious NDC number assigned by the chemical manufacturer, but again, it is false because only the FDA can assign such a number.

As such, submitting a claim to an insurance carrier with knowingly false or fraudulent information could result in civil and criminal penalties, including the forfeiture of the license to practice pharmacy.

But I usually have just a copay.
For this to be possible, the pharmacy must have a contract with the PBM to file your claim electronically. However, the pharmacy may not be able to comply with the terms of the PBM contract. These contracts have routinely and historically been non-negotiable, and require fraudulent use of NDC numbers. Even though our practice and staff are devoted to the art and science of compounding and nutrition, we would also be required to fill all types of prescriptions for all patients, in a high-volume prescription environment demanded by the PBM.

How do I get reimbursed?
The patient pays for their prescription at the time of service. We have many insurance forms on file and can assist the patient in their accurate submission for reimbursement. Please see supporting documents.