New Program Features

Per Centers for Medicare & Medicaid Services (CMS) guidelines: 

When a prescription claim for a compound medication containing multiple ingredients is used for a diagnosis or via a route of administration that is not supported by the Medicare approved references, the compound is no longer considered eligible for payment under Medicare Part D. 

When a prescription claim for a compound medication contains ingredients that can be covered under Medicare Part D or Part B depending on the situation, the compound must be evaluated for coverage under the appropriate Medicare Part D or Part B benefit.

*Please see attached for more information.