How compounded drug is billed?
Started by marscole
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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.
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.
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.
