A number of agents will not be covered, which may cause compound claims to reject with NCPDP Reject 70 (Product/Service Not Covered), along with the Reject Field Occurrence Indicator (in NCPDP Field 546-4F) denoting the non-covered ingredient.

If this reject occurs, pharmacists may use one of the following options:

• With approval of the prescribing physician, the non-covered ingredient may be switched to a covered ingredient or the member may be switched to another FDA-approved drug.

• Re-submit the claim as-is using Submission Clarification Code 8 in NCPDP Field 420-DK to accept non-payment for non-covered ingredients. Please note SCC 8 may not be allowed for all scenarios and/or benefit designs.

It is not recommended that pharmacists remove the non-covered ingredient in order to receive a paid response for the claim. In addition, providers may not attempt to circumvent the plan sponsor’s benefit design and coverage of compounded prescriptions or compound ingredients; including, but not limited to, re-submitting rejected compound prescription ingredients as individual, non-compound prescription claims.

Following are some common excluded products (not an all-inclusive list):

• Neutraceuticals, such as herbs; root extracts; homeopathic remedies; medical foods
• "Wellness" ingredients
• Ingredients used for cosmetic purposes such as bleaching and to promote hair growth
• Weight loss ingredients
• Ingredients used for anti-aging purposes
• Protein powders