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

Senior person holding tissue roll near a toilet bowl, using walker to walk to the bathroom stock photo
Is Emsella Covered by Medicare?
Nov 21, 2022
Teenager Helping his Grandfather at Home stock photo
Does Medicare Cover Geri Chairs?
Dec 7, 2022
Cover image
Does Medicare cover Hyoscyamine?
Nov 30, 2022
Senior couple going over their finances in front of a computer stock image
How Much Does Medicare Part B Cost in 2023?
Dec 27, 2022
Kidney stone stock image
Does Medicare Cover Kidney Stone Removal?
Nov 23, 2022
stack of books stock image
Do You Need Books on Medicare?
Apr 6, 2023
Fair Square
Do I Need to Renew My Medicare?
Nov 29, 2022
Medigap stock image
When Can You Change Medicare Supplement Plans?
Nov 18, 2022
Cover image
The Fair Square Bulletin: February 2024
Feb 15, 2024
Medicare Explained Thumbnail
Medicare Explained
Jan 3, 2022
surgeons working over a patient stock image
Does Medicare Cover LVAD Surgery?
Nov 30, 2022
Senior man receiving care from an optometrist stock photo
Does Medicare Cover Cataract Surgery?
Dec 22, 2022
a doctor tells her patient she doesn't accept medicare. the patient wonders what to do stock image
What to Do When Your Doctor Doesn't Take Medicare
Feb 24, 2023
Cover image
Is Fair Square Medicare Legitimate?
Jul 27, 2023
COVID-19 at home test stock image
Does Medicare Cover COVID Tests?
Dec 21, 2022
Costco & Fair Square
Costco Pharmacy Partners with Fair Square
Jan 13, 2023
senior man receiving dental care stock photo
Will Medicare Cover Dental Implants?
Jun 2, 2022
Cover image
2024 Medicare Price Changes
Oct 30, 2023

More of our articles

13 Best Ways for Seniors to Stay Active in Indianapolis

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

Are Medicare Advantage Plans Bad?

Building the Future of Senior Healthcare

Can Doctors Choose Not to Accept Medicare?

Can I Choose Marketplace Coverage Instead of Medicare?

Can I Have Two Primary Care Physicians?

Can Medicare Advantage Plans be Used Out of State?

Can Medicare Advantage Plans Deny Coverage for Pre-Existing Conditions?

Can Medicare Help with the Cost of Tyrvaya?

Do All Hospitals Accept Medicare Advantage Plans?

Do Medicare Supplement Plans Cover Dental and Vision?

Does Medicare Cover Abortion Services?

Does Medicare Cover Breast Implant Removal?

Does Medicare Cover Chiropractic Visits?

Does Medicare cover Deviated Septum Surgery?

Does Medicare Cover Diabetic Eye Exams?

Does Medicare Cover ESRD Treatments?

Does Medicare Cover Fosamax?

Does Medicare Cover Hearing Aids?

Does Medicare Cover Home Heart Monitors?

Does Medicare Cover Iovera Treatment?

Does Medicare Cover Linx Surgery?

Does Medicare Cover Mental Health?

Does Medicare Cover Nexavar?

Does Medicare Cover Ofev?

Does Medicare Cover Oxybutynin?

Does Medicare Cover RSV Vaccines?

Does Medicare Cover SIBO Testing?

Does Medicare Cover Tymlos?

Does Medicare Cover Urodynamic Testing?

Does Medicare Cover Vitamins?

Does Medicare Cover Xiafaxan?

Does Medicare Cover Zilretta?

Does Medicare Pay for Antivenom?

Does Medicare Pay for Funeral Expenses?

Does Medicare pay for Opdivo?

Does Your Medicare Plan Cover B12 Shots?

Explaining the Different Enrollment Periods for Medicare

Finding the Best Dental Plans for Seniors

Health Savings Accounts (HSAs) and Medicare

How Can I Get a Replacement Medicare Card?

How Does Medicare Cover Colonoscopies?

How Does Medicare Pay for Emergency Room Visits?

How is Medicare Changing in 2023?

How Much Does Medicare Part A Cost in 2023?

How Much Does Xeljanz Cost with Medicare?

How Often Can I Change Medicare Plans?

How to Choose a Medigap Plan

How to Enroll in Social Security

How Your Employer Insurance and Medicare Work Together

Is Balloon Sinuplasty Covered by Medicare?

Medicare & Ozempic

Medicare 101

Medigap vs. Medicare Advantage

The Easiest Call You'll Ever Make

The Fair Square Bulletin: August 2023

The Fair Square Bulletin: November 2023

The Fair Square Bulletin: October 2023

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

What If I Don't Like My Plan?

What Is a Medicare Advantage POS Plan?

What Is a Medicare Supplement SELECT Plan?

What is the 8-Minute Rule on Medicare?

What Is the Medicare Birthday Rule in Nevada?

What is the Medicare ICEP?

What You Need to Know About Creditable Coverage

What's the Difference Between HMO and PPO Plans?

Why Is Medicare So Confusing?

Why You Should Keep Your Medigap Plan

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 2024

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. © 2024 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