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*