Fair Square Medicare Wordmark

Does Medicare Cover Compounded Medications?

scientist mixing chemical compounds stock image
By Daniel Petkevich
Apr 4, 2023

Your plan should fit your prescription drug needs

Your prescription drugs don't have to be “One Size Fits All.” Compounded medications can offer flexibility and specialization when taking your prescriptions. But can they fit into your Medicare budget? Or do you have to pay for compounded medications out-of-pocket? Read on as we take a look at compounded medications on Medicare.

Stay Up to Date on Medicare!

Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.
Note: This content is for informational purposes only. You should consult with your doctor before taking any medication, including compounded medications.

What are Compounded Medications and why they may be needed 

Compounded medications are what they sound like. They are drugs mixed and prepared specifically for you at a compound pharmacy. These special medications allow for greater customization in your healthcare, as these combinations can be tailor-made. According to

GoodRx

, some of the examples of medical professionals who might prescribe compounded medications include:
  • Dermatologists
  • Pain specialists
  • Podiatrists
  • Endocrinologists
  • Gastroenterologists
  • And more
While there are many useful applications for compounding medications, there are also some potential drawbacks. 

Does Medicare Part D Cover Compounded Medications? 

The answer to this question will depend on the specific medications you are using and the dosage. Generally,

Medicare

will not cover compounded medications. There might be some exceptions if the drugs that are compounded are both within their standard dosage and are listed on your Part D plan’s formulary. But as a rule of thumb, you should prepare for Medicare not to offer coverage for your compounded medications. 

How to Find Out if Your Plan Covers Compounding?

The best way to determine if your Medicare Part D plan covers compounded medications is to review your plan's formulary, which is a list of covered medications. You can find this information on your plan's website or by calling your plan's customer service number.
When you review the formulary, look for a section that specifically lists compounded medications. If you do not see this section, you can also search for the specific ingredients in your compounded medication to see if they are covered under your plan.
It is also important to note that even if a compounded medication is covered under your plan, it may require prior authorization or have other restrictions, such as quantity limits or step therapy requirements. So, be sure to carefully review your plan's details and contact your plan if you have any questions or concerns.

Approaching Compounded Medications with Caution 

If you are interested in or have already done additional research on compounded medications and Medicare, you might have seen an

HHS report

from 2014 about payment and oversight of compounded medications on

Part B of Medicare

. The report, likely introduced as a result of the fungal meningitis outbreak in 2012, acknowledged that certain compounded drugs can be covered by Part B, but that there have been issues with contamination. Following this report, the contamination and Medicare spending on compounded drugs have been under closer scrutiny. They might not be FDA-approved, and that means it can come with risks to your health in addition to your budget. 

Tips for Saving Money on Compounded Medications  

At Fair Square, we want to empower you to be your own best advocate. With that in mind, here are a few tips that

Medicare

beneficiaries can follow to save money on compounded medications:
  • Check with your

    Medicare Part D plan

    : Some Medicare Part D plans may offer coverage for compounded medications, so it is important to check with your plan to see if this is the case.
  • Consider alternative treatments: In some cases, there may be alternative treatments available that are covered by Medicare and do not require compounding. Talk to your healthcare provider to see if there are other options available for your condition.
  • Shop around for the best price: If you do need a compounded medication, shop around at different pharmacies to find the best price. Some pharmacies may charge more for compounded medications than others. 
  • Ask for a cash price: In some cases, it may be less expensive to pay for a compounded medication out-of-pocket rather than using your insurance. Ask the pharmacy for a cash price and compare it to what you would pay with your insurance.
  • Consider using a compounding pharmacy: While Medicare does not cover compounded medications, some compounding pharmacies offer discounts or payment plans for patients who are paying out of pocket. Ask your healthcare provider or pharmacist for recommendations on compounding pharmacies in your area.
It is important to note that the safety and effectiveness of compounded medications may vary as they are not regulated by the FDA. It is important to discuss the risks and benefits of compounded medications with your healthcare provider before using them.

Questions to Ask About Coverage for Compounding Services

How do you know if your medication is compounded?
Ask your healthcare provider. They will be able to talk with you about the specifics of the medication you’re taking, and what your options are if you are interested in making a change.
What is a compounding pharmacy?
A compounding pharmacy is different from your average pharmacy. They can customize medications for you and for others who are looking for a more specific medication. You can do internet research on compounding pharmacies in your area, and speak with your Medicare plan provider to see if they are covered under your Part D plan.
What are some alternatives to compounded medications that are covered by Medicare?
There may be alternative treatments available that are covered by Medicare and do not require compounding. Talk to your healthcare provider to see if there are other options available for your condition. For example, there may be FDA-approved medications or medical devices that can be used instead of compounded medications.
How do I talk to my healthcare provider about compounded medications?
It's important to have an open and honest conversation with your healthcare provider about compounded medications. You can start by asking if there are any FDA-approved medications or treatments available for your condition. If your healthcare provider suggests a compounded medication, you can ask about the risks and benefits, as well as any potential alternatives. It's important to make sure you understand why the compounded medication is being recommended and how it will be prepared.
How do I know if a compounded medication is the right choice for my health condition?
The decision to use a compounded medication should be made in consultation with your healthcare provider. Your healthcare provider can help determine if a compounded medication is necessary and appropriate for your health condition. It's important to consider the risks and benefits of using a compounded medication, as well as any potential alternatives. Your healthcare provider can also help you understand the preparation and administration of the compounded medication, as well as any potential side effects or interactions with other medications you may be taking. Ultimately, the decision to use a compounded medication should be based on your individual healthcare needs and goals.

Conclusion

In conclusion, compounded medications can offer flexibility and specialization when taking your prescriptions. However, when it comes to Medicare coverage, the answer is not so straightforward. Generally, Medicare will not cover compounded medications, but there might be some exceptions if the drugs are listed on your Part D plan's formulary. It is important to approach compounded medications with caution as they may not be FDA-approved and can come with risks to your health and budget. Always consult with your doctor before taking any medication, including compounded medications, and follow these tips to save money on compounded medications while ensuring your safety and well-being. For all of your

Medicare questions

,

Fair Square

is here for you. Give us a call at 888-376-2028.

Stay Up to Date on Medicare!

Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.

Recommended Articles

woman in a therapist office stock photo
Does Medicare Cover Hypnotherapy?
Nov 22, 2022
Male doctor with his arms crossed stock image
Can Doctors Choose Not to Accept Medicare?
Dec 8, 2022
Cover image
What Is a Medicare Advantage POS Plan?
May 10, 2023
Cover image
Does Medicare Cover Shock Wave Therapy for Plantar Fasciitis?
Nov 30, 2022
A women's restroom sign that has been modified to show the stick figure woman needing to use the toilet
Does Medicare Cover Bladder Sling Surgery?
Jan 11, 2023
male driver taking notes from behind the wheel stock image
Does Medicare Cover Driving Evaluations?
Dec 1, 2022
Cover image
Does Your Plan Include A Free Gym Membership?
Jul 12, 2023
alphabet_soup
How to Choose a Medigap Plan
Jan 10, 2023
A doctor with a clipboard consults a female patient with cancer
Does Medicare Cover Inqovi?
Jan 11, 2023
various cartoon scenarios showing long term care stock photo
Which Medigap Policies Provide Coverage for Long-Term Care?
Sep 16, 2022
Leg bones and knees, 3d rendering. stock photo
Does Medicare Cover Boniva?
Nov 29, 2022
Illustrated referential images of a hospital bill, coins, cash in a wallet, a calculator, and a magnifying glass
What Are Medicare Part B Excess Charges?
Jan 6, 2023
Fair Square
Is Displacement Affecting Your Medicare Coverage?
Oct 6, 2022
An elderly couple discusses their healthcare and insurance needs with another woman stock image
Medicare Guaranteed Issue Rights by State
Feb 10, 2023
Cover image
Can I Use Medicare Part D at Any Pharmacy?
Aug 28, 2023
Closeup of a male Doctor or physiotherapist doing stretching for a patient in the clinic for examining treating injured of back stock photo
Does Medicare Cover Chiropractic Visits?
Dec 22, 2022
elderly woman with glasses having difficulty reading her phone stock image
Is Vitrectomy Surgery Covered by Medicare?
Dec 2, 2022
Cover image
The Fair Square Bulletin: July 2023
Jul 17, 2023

More of our articles

13 Best Ways for Seniors to Stay Active in Columbus

13 Best Ways for Seniors to Stay Active in Philadelphia

13 Best Ways for Seniors to Stay Active in Phoenix

14 Best Ways for Seniors to Stay Active in Nashville

14 Best Ways for Seniors to Stay Active in Washington, D.C.

2023 Medicare Annual Election Period (AEP)

2024 "Donut Hole" Updates

Building the Future of Senior Healthcare

Can I Have Two Primary Care Physicians?

Can I Laminate My Medicare Card?

Can Medicare Help with the Cost of Tyrvaya?

Costco Pharmacy Partners with Fair Square

Do Medicare Supplement Plans Cover Dental and Vision?

Do You Need Medigap if You're Eligible for Both Medicare and Medicaid?

Does Medicare Cover an FMT?

Does Medicare Cover Bariatric Surgery?

Does Medicare Cover Cartiva Implants?

Does Medicare Cover Cataract Surgery?

Does Medicare Cover Cervical Disc Replacement?

Does Medicare cover Deviated Septum Surgery?

Does Medicare Cover Diabetic Eye Exams?

Does Medicare Cover Disposable Underwear?

Does Medicare Cover Exercise Physiology?

Does Medicare Cover Fosamax?

Does Medicare Cover Home Heart Monitors?

Does Medicare Cover Incontinence Supplies?

Does Medicare Cover Inspire for Sleep Apnea?

Does Medicare Cover Iovera Treatment?

Does Medicare Cover Jakafi?

Does Medicare Cover Krystexxa?

Does Medicare Cover Kyphoplasty?

Does Medicare Cover Light Therapy for Psoriasis?

Does Medicare Cover Ofev?

Does Medicare Cover Orthodontic Care?

Does Medicare Cover Oxybutynin?

Does Medicare Cover SIBO Testing?

Does Medicare Cover Urodynamic Testing?

Does Medicare Cover Xiafaxan?

Does Medicare Pay for Allergy Shots?

Does Medicare Pay for Antivenom?

Does Medicare Require a Referral for Audiology Exams?

Does Retiring at Age 62 Make Me Eligible for Medicare?

Does Your Medicare Plan Cover B12 Shots?

Estimating Prescription Drug Costs

Explaining IRMAA on Medicare

Explaining the Different Enrollment Periods for Medicare

Fair Square Bulletin: We're Revolutionizing Medicare

Finding the Best Vision Plans for Seniors

Health Savings Accounts (HSAs) and Medicare

How Does Medicare Pay for Emergency Room Visits?

How Much Does Medicare Cost?

How Much Does Medicare Part B Cost in 2023?

How Much Does Trelegy Cost with Medicare?

How Often Can I Change Medicare Plans?

How Your Employer Insurance and Medicare Work Together

Is Balloon Sinuplasty Covered by Medicare?

Is Fair Square Medicare Legitimate?

Medicare & Ozempic

Medicare Consulting Services

Medigap vs. Medicare Advantage

Should You Work With A Remote Medicare Agent?

The Easiest Call You'll Ever Make

The Fair Square Bulletin: August 2023

The Fair Square Bulletin: June 2023

The Fair Square Bulletin: The End of the COVID Emergency Declaration

What If I Don't Like My Plan?

What To Do If Your Medicare Advantage Plan Is Discontinued

What You Need to Know About Creditable Coverage

What's the Deal with Flex Cards?

When to Choose Medicare Advantage over Medicare Supplement

Why You Should Keep Your Medigap Plan

Will Medicare Cover Dental Implants?

Your Medicare One-Stop-Shop

Your guide to Medicare Parts A & B, Medicare Advantage, and Medigap. 100% free.
Get the Fair Square Bulletin

Medicare savings tips, helpful guides, and more.

About

Medicare 101

Current Clients

Medicare Supplement Plans

Medicare Advantage Plans

Fair Square 2023

Terms of Use
Notice of Privacy Practices

Virgil Insurance Agency, LLC (DBA Fair Square Medicare) and www.fairsquaremedicare.com are privately owned and operated by Help Button Inc. Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. This is a solicitation of insurance. A licensed agent/producer may contact you. Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and, in some states, to those under age 65 eligible for Medicare due to disability or End-Stage Renal disease. Virgil Insurance Agency is a licensed and certified representative of Medicare Advantage HMO, HMO SNP, PPO, PPO SNP and PFFS organizations and stand-alone PDP prescription drug plans. Each of the organizations we represent has a Medicare contract. Enrollment in any plan depends on contract renewal. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. Plan availability varies by region and state. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. © 2022 Help Button Inc

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

MULTIPLAN_FairSquareMedicare_01062022_M