For years, Medicare and Medicaid have not paid for most compounded medications . This lack of coverage has occurred for a variety of reasons including rebates to the Medicaid system and Medicare Part-D law. I have been searching for solutions to remedy this problem for years, especially for my topical pain management patients. I may have finally found an answer.
By combining commercially available tablets and creams, most insurance companies and government payers (including Tricare®) may cover topical pain gels. This approach does not allow us as much flexibility as our traditional compounding techniques and compounding from raw active ingredients is still preferred. Combining the commercially available tablets and creams, however, may provide an effective solution for pain management when coverage for other options fail.
If you have been denied coverage in the past for topical pain creams or gels, give us a call. Ask to speak with Adam King, LPhT, PRS, and he will do everything to see if a new formula will be covered for you. We will then coordinate with your physician to obtain a prescription for the covered formula.
Thank you for using Keystone Pharmacy. ask me a question We are always seeking ways to innovate on your behalf.
by David J. Miller, RPh, PhD, FIACP, FACA