Blue Cross Blue Shield Position in Tennessee on Reimbursement for Compounds

COMPOUND DRUG INFORMATION

Compound drugs, which require a prescription from a doctor, are prepared by a pharmacist who mixes or adjusts drug ingredients to customize a medication to meet a patient’s individual needs. 

Differences Between Compound Drugs and Other Prescription Drugs

Compound drugs often have the same active ingredients as brand-name and generic prescription drugs but can differ from these medications in:

• strength – compound drugs can be prepared in strengths not usually available;
• inactive ingredients – compound drugs can be made without some of the dyes, sugars, preservatives and other inactive ingredients found in regular prescription drugs; or
• form – compound drugs can be prepared as lozenges or syrups instead of hard-to-swallow pills or in other forms that are not usually available..

Coverage for Compound Drugs
Check your Evidence of Coverage (EOC) or member handbook to see if your plan covers compound drugs.

If compound drugs are covered by your plan, it’s important to remember that pharmacies that are in-network for regular prescription drugs may be out-of-network for compound drugs. Based on your pharmacy plan, you may not have to pay 100 percent of the drug’s cost if the pharmacy is in-network for compound drug prescriptions.  Check your EOC or member handbook for more information on your plan's required copayment and/or deductible amounts.

You may have to pay more out of your pocket if you have a prescription for a compound drug filled at a pharmacy that is not in-network for compound drugs.  Check your EOC or member handbook for more information on your plan's coverage for compound drugs purchased at a non-participating pharmacy.

If you have mail order benefits, you can obtain your compound drugs from the mail facility and have your mediations shipped directly to you. 

Choosing a Compound Pharmacy

If you use compound drugs, make sure the pharmacy you use is in-network for filling compound drug prescriptions.  You can do this three different ways:

• Call the pharmacy you use and ask if they are in-network for compound drugs.
• Use our “Find a Pharmacy” tool.
• Call the Member Service number on your ID card.

How to Use the Online “Find a Pharmacy” Tool to Find a Compound Pharmacy:

• Select your Pharmacy Network.  It is listed on your BlueCross BlueShield of Tennessee ID card -- for example, RX01.
• Select the “Compound Pharmacy” option in the box underneath the Pharmacy Network field to make sure your search is for pharmacies in-network for compound drugs. 
• You may also enter your favorite pharmacy’s name, your city, state, zip code or county to narrow your search.
• Click the “Search” button once you have selected or entered all the appropriate information.

Remember -- Pharmacies that are in-network for regular prescription drugs may be out-of-network for compound drugs.  If you fill a prescription for a compound drug at a pharmacy that is not in-network for compound drugs, you may have to pay more out of your pocket for your medication.

Information is from here.