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Compound Drug Coverage

Harvard Pilgrim only covers compounded medications that are medically necessary for your adult patient's care.

How Do I Request Coverage for a Compounded Medication?
You may submit a Compound Exceptions Request Form for coverage of a compounded medication on behalf of your patient. We will make a decision on whether a compounded medication will be covered within 48 hours of receiving the request, based on whether use of a compounded medication is medically necessary.

Completed Medication Request forms should be submitted to:
MedImpact Healthcare Systems
Fax: 888-807-6643
Telephone: 800-788-2949

What Happens if my Request is Denied by Harvard Pilgrim?
If Harvard Pilgrim denies your request for coverage of a compounded medication, your patient may file an appeal. We provide a detailed description of member appeal rights in your patient's Benefit Handbook. Your patient may also call Harvard Pilgrim Member Services for information on how to file an appeal.

If you have any questions about Harvard Pilgrim's coverage for compounded medications, please call Harvard Pilgrim Pharmacy Services at (617) 509-9060.