Harvard Pilgrim Health Care Home
  HPHConnect
 
  Learn more.
  Sign up for HPHConnect.
Medical Management
E-Transactions
HPHConnect
Pharmacy
For Your Patient
News Center
Network Matters
Newsletter Archives
Newsletter Registration
Newsroom
Office Support
Products
Provider Manual
Medicare Advantage
Research & Teaching
Resources & Links
 
Print    Text Size

Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

June 2013

Compounded Prescriptions Benefit Change 


Effective on August 7, 2013, Harvard Pilgrim will no longer provide coverage for compounded prescription medications for members age 18 and older.

This decision is based on safety and cost considerations. As you know, compounded drugs are not approved by the U.S. Food and Drug Administration (FDA). This means that the FDA does not verify the safety and effectiveness of compounded drugs and that compounded drugs lack the FDA’s finding of manufacturing quality. Additionally, the cost of these drugs isn’t adequately controlled.

This change does not apply to members under age 18 because compounding is sometimes necessary to make certain medications appropriate for children. In most instances, compounding for this age group consists of making an FDA-approved prescription medication more palatable for kids, for example converting a pill into a smaller, easier-to-swallow capsule or altering the dose.

If you are currently prescribing a compounded drug for a Harvard Pilgrim adult member, it is likely that our comprehensive, open formulary includes an FDA-approved medication that can treat your patient’s condition. If one of these covered, FDA-approved medications is prescribed, the member is responsible for the copayment as determined by that person’s benefit plan.

However, if the member continues to use a compounded drug, the individual will be responsible for paying the full cost of the medication, with payment made directly to the pharmacy.

If you believe that there are no other available treatment options for your Harvard Pilgrim patient, you may submit an exception request on their behalf. Exceptions requests should be submitted to:

Harvard Pilgrim Pharmacy Services
93 Worcester Street; 4 East
Wellesley, MA 02481
Fax: 617-509-9144
E-mail: pharmacy_services@harvardpilgrim.org

Please include the following:

  • Member Name
  • HPHC ID#
  • Diagnosis being treated
  • Compound being requested (list of all ingredients)
  • Quantity being requested
  • Length of treatment
  • Compounding pharmacy being used
  • Other prescription medications tried to treat this condition
  • Other information that may be helpful in considering coverage

Email this article to a colleague   

Receive Network Matters by e-mail

Network Matters Archives

Download printer-friendly version

HPHCURRENT EVENTS

SaveOnSM Program Now Available for Maine Employers

GIC Product Updates Effective July 1

Are You Ready for ICD-10 Transition?

CLINICIAN CORNER

Expanded Coverage of Stereotactic Radiosurgery

Coverage for Amylase Testing

Compounded Prescriptions Benefit Change

Treating Insomnia in the Primary Care Setting

OFFICE ASSISTANT

Updated Pricing for Molecular Pathology Codes

PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Richard Weisblatt PhD,
Senior Vice President, Provider Network

Joann Peck,
Manager, Network Planning and Administration

Annmarie Dadoly,
Editor

Kristin Edmonston,
Production Coordinator