How compounded drug is billed?

[marscole]

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I wonder how many compounding pharmacists at here, so I wonder how compounded drug is billed? How Medicare and Medicaid reimburse it? My rotation site didn't want to disclose any information due to the competitors.

Anyone please... Thank you!!

 

[genesis09]

For Medicare part D plans, you cannot bill for drug powder. For Medicaid, that is a state by state issue.

 

[vmol]

Am interested to know too . Please anybody compounding in New Jersey?

 

[BidingMyTime]

in general, compounded drugs are billed on the costs of all the ingredients used to make it, and the expected/average length of time it would take to make that compounded drug. Whether or not the pharmacy is actually reimbursed for all of that depends completely on the insurance, but for a cash-paying patient, they are paying for the drug ingredients/markup and the time involved in making the compound.

 

[vmol]

What are the day to day book keeping for compounding prescriptions . What i do is daily lab book . Approved formula if available. Certificate of analysis of chemicals i use .

 

[vmol]

Please share your knowledge and information regarding the documents and required things tht we should do . That sudden inspectors will look for upon inspection

 

[Longhorn08]

Medicare will only cover crushed tablets and emptied out capsules. Medicaid depends on the state.

It really varies per plan on Medicare what they do and do not cover. Many plans have decreased their limits for maximum claims.

As far as record keeping, you may want to check with your state. We have our logs saved electronically. We have our maser formulations saved electronically. I know other states require that you have printed hard copies of master formulations.

You must have MSDS, CoAs, invoices. Separate stock of dangerous drugs (hormones, controlled substances, carcinogenic, teratogenic, etc).

You have to have a policy and procedure manual and trained staff. You'll have to have proof of training them.

If you use a sales force, they must be w2 employees.

 

[vmol]

Great information thank you soo much