Blue Cross position in Michigan regarding compounded drugs

August 2012

Compounded prescriptions covered only if all ingredients covered

Beginning Aug. 1, 2012, for Blue Cross Blue Shield of Michigan commercial (non-Medicare) customers and Sept 1, 2012, for Blue Care Network commercial (non-Medicare) customers, when a customer fills a prescription for a compounded drug, each ingredient in the compound must be covered under the member’s plan in order for the prescription to be payable. If a compound contains a product that is not covered under the member’s plan, even if it has been covered for a member in the past, the claim will now be rejected.

All other pharmacy benefit exclusions and limitations will also apply to compounds, including off-label exclusions, quantity limits for drugs used for erectile dysfunction and exclusions for both cosmetic use and bulk chemicals. Some exceptions exist for select over-the-counter products used as compound vehicles. Please discuss alternatives with your patients.

If you have questions about these changes, please call the Pharmacy Services Clinical Help Desk at
1-800-437-3803 and follow the prompts to reach the BCBSM or BCN prior authorization line.

Members who would like more information about any of their prescription drug benefits can be directed to call the customer service number on the back of their Blues ID cards.