Billing Bulk Powders for Topical Compounds

[Sparda29]

Are there any insurance companies that cover the bulk powders for topical compounds anymore? It seems just not worth it to make these compounds unless we already have a well paying commercially made cream/ointment involved in the compound.

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[Dred Pirate]

Most places I know - but I have been out of the retail world for a while, see, to refer those patients to specialty compounding pharmacies that don't take insurance, or have special agreements.

 

[Sparda29]

Most places I know - but I have been out of the retail world for a while, see, to refer those patients to specialty compounding pharmacies that don't take insurance, or have special agreements.

Nope, this pharmacy caters mainly to Medicaid or Medicare patients. The owner meets with the docs who usually send patients our way and suggests compounds for the doctor to prescribe. I'm trying to come up with compounds that don't require prior authorizations and make more than $200 profit/compound. I know of some pharmacies who make topical pain compounds and get paid out more than $1000 for a 4 ounce jar of the compound.

 

[Dred Pirate]

Nope, this pharmacy caters mainly to Medicaid or Medicare patients. The owner meets with the docs who usually send patients our way and suggests compounds for the doctor to prescribe. I'm trying to come up with compounds that don't require prior authorizations and make more than $200 profit/compound. I know of some pharmacies who make topical pain compounds and get paid out more than $1000 for a 4 ounce jar of the compound.

is that slightly pushing the limits of the lay? You can say you compound, but from what I remember from my law exams - you can specifically say you can compound product XYZ?

 

[zelman]

is that slightly pushing the limits of the lay? You can say you compound, but from what I remember from my law exams - you can specifically say you can compound product XYZ?

I think that's related to advertising publicly. Discussions with doctors aren't regulated the same way.

 

[Sparda29]

Like the main thing I'm having trouble with right now is this pain compound that calls for 24 g of gabapentin in a 240 gram compound. I could either use 24 g of gabapentin powder from Medisca (costs $75 but insurance doesn't pay for it), or use #60 gabapentin 400 mg capsules and using the powder within the capsules, cheap from our secondary wholesaler and paid for but a pain in the ass to open up 60 capsules for each compound.

 

[ExpressMaiL]

Like the main thing I'm having trouble with right now is this pain compound that calls for 24 g of gabapentin in a 240 gram compound. I could either use 24 g of gabapentin powder from Medisca (costs $75 but insurance doesn't pay for it), or use #60 gabapentin 400 mg capsules and using the powder within the capsules, cheap from our secondary wholesaler and paid for but a pain in the ass to open up 60 capsules for each compound.

Have the intern open up the capsules.

 

[Sparda29]

Have the intern open up the capsules.

Exactly what I'm doing.

 

[Dr Wario]

Like the main thing I'm having trouble with right now is this pain compound that calls for 24 g of gabapentin in a 240 gram compound. I could either use 24 g of gabapentin powder from Medisca (costs $75 but insurance doesn't pay for it), or use #60 gabapentin 400 mg capsules and using the powder within the capsules, cheap from our secondary wholesaler and paid for but a pain in the ass to open up 60 capsules for each compound.

Knowing you, buy/use the bulk powder and bill for the capsules.

 

[Sparda29]

Knowing you, buy/use the bulk powder and bill for the capsules.

Nooo, the capsules cost like $2.28 but the powder costs $75 for the same amount.

 

[297point1]

Knowing you, buy/use the bulk powder and bill for the capsules.

Knowing him...I think you got that backwards.

 

[Ackj]

Nooo, the capsules cost like $2.28 but the powder costs $75 for the same amount.

What's the reimbursement on the capsule route? From my (very limited) experience, 3rd party reimburses barely anything beyond what the ingredients would cost, so in this case it would be essentially the same as an rx for #60 gabapentin.

 

[Sparda29]

Knowing him...I think you got that backwards.

They don't pay for the bulk powder.

What's the reimbursement on the capsule route? From my (very limited) experience, 3rd party reimburses barely anything beyond what the ingredients would cost, so in this case it would be essentially the same as an rx for #60 gabapentin.

Ehh, it's like $5 reimbursement on the caps, but the Lidocaine-Prilocaine 2.5-2.5% cream or Lidocaine 5% ointment are usually covered and that's what pays the big reimbursement, and we get those at a discount since they are shortdated to expire within 6 months, but since the compound will be used up by the patient within a month, it works out. Mix that with bulk powder of diclofenac and amitriptyline and you can bill for level of effort 3 and you usually get a dispensing fee of $30+.