Individual Medicare plans move compound drugs off formulary beginning January 1, 2019
December 2018 Empire Provider Newsletter
Dec 1, 2018 • State & Federal / MedicareBeginning January 1, 2019, Individual Medicare Advantage plans will move compounded drugs to non-formulary with the exception of home infusion drugs. Group-sponsored Medicare Advantage members will continue to have compounded drug coverage; these drugs will require prior authorization. Compounded home infusion drugs will continue to be covered for both Individual Medicare and group-sponsored members without prior authorizations. Members and/or providers can request a non-formulary exception for compounded drugs.