Does Medicaid Cover Compounded Prescriptions?

Medicaid is a government program that provides health coverage to people who cannot afford it. It’s usually for low-income families and individuals, pregnant women, children, and the disabled.

The federal government sets guidelines for what Medicaid does and doesn’t cover. It is a common question among those on Medicaid: Does Medicaid cover compounded prescriptions? The answer can be both yes and no.

If you are a Medicaid recipient, then the answer to this question is probably yes, but it depends on where you live. Compounded prescriptions are not covered by most insurance plans, including Medicaid, but some states have enacted laws to make it mandatory for pharmacies in that state to provide these compounded medications free of charge.

Are Compounded Drugs Covered by Insurance?

Compounded drugs are sometimes made when pharmaceutical manufacturers cannot produce doses that are small or large enough to treat a specific patient. They also may be created for the patient’s specific needs, such as putting a drug in lollipop versus pill form for a patient who has trouble swallowing pills.

Compounded drugs are typically not covered by insurance. Compounded medications are customized and therefore can’t be approved or viewed as a single entity. Compound drugs are also designed to treat specific conditions, some of which may be considered “off-label” uses by insurance providers.

The FDA also does not regulate compounding pharmacies, which is why some insurance companies don’t feel comfortable paying for their products.

Compounded Prescriptions Covered by Medicaid for Eligible Members

New York Medicaid members may be eligible for Medicaid compounded prescription benefits and do not need approval from their doctor or healthcare provider before receiving these medications.

However, it’s important to check with your local pharmacy or the pharmacist who compounds the medication because a compounded medication may be considered an “off-label” use of the drug.

The New York State Medicaid program also covers some compounded prescriptions to people who participate in a Medicare Part D or Medicare Advantage Drug Contracting (MAPD) plan. All other prescription drugs that are not covered by Medicaid should be paid for through the Part D policy.

For the most up-to-date coverage information, you should check out the Medicaid list of reimbursable drugs.

Contact a Compounding Pharmacy in New York

If you would like to know more about how Medicaid covers compounded prescriptions, The Healthy Choice compounding pharmacy is here to help. Give us a call today at 914-238-1700 to speak with an experienced member of our team or request your consultation online through our contact form.