Compounded Drugs. Compounded drugs will be covered only if obtained from Fairview Compounding Pharmacy or other designated compounding pharmacy provided that at least one active ingredient is a prescription drug. Payment for a compounded drug that has a commercially prepared product available that is identical to or similar to the compounded drug will be considered for coverage after documented failure of the commercially prepared product(s), unless a formulary exception is obtained. A commercially prepared product is one that is available at the pharmacy in its final, usable form and does not need to be compounded at the pharmacy. The applicable formulary benefit level will be applied. Compounded drugs containing any product that is excluded by PIC will not be covered, including dosages and route of administration that have not been approved by the FDA.
Compounded Drugs. Compounded Drugs are prescription orders that have at least one ingredient that is Federal Legend or state restricted in a therapeutic amount as Medically Necessary and are combined or manufactured by the pharmacist and placed in an ointment, capsule, tablet, solution, suppository, cream or other form and require a prescription order for dispensing. Compounded Drugs (that use FDA approved drugs for an FDA approved indication) are covered. Coverage for Compounded Drugs is subject to Prior Authorization by the Plan and Medical Necessity. Refer to the "Off-Label Drugs" provision in the "Prescription Drugs" portion of the "Cov- ered Services and Supplies" section for information about FDA approved drugs for off-label use. Coverage for Compounded Drugs requires the Level IlI Drug Copayment and is subject to Prior Authorization by the Plan and Medical Necessity. Sexual Dysfunction Drugs Drugs that establish, maintain or enhance sexual functioning are covered for sexual dysfunction when Medically Necessary. These Prescription Drugs are covered for up to the number of doses or tablets speci- fied in Health Net’s Recommended Drug List. For information about Health Net’s Recommended Drug List, please call the Customer Contact Center at the telephone number on your ID card. Oral Infertility Drugs Oral Infertility Drugs are covered when prescribed by a Physician through SELECT 1. These drugs are not covered when prescribed by a Physician through SELECT 2 and SELECT 3.
Compounded Drugs. Compounded Drugs are prescription orders that have at least one ingredient that is Federal Legend or state restricted in a therapeutic amount as Medically Necessary and are combined or manufactured by the pharmacist and placed in an ointment, capsule, tablet, solution, suppository, cream or other form and require a prescription order for dispensing. Compounded Drugs (that use FDA approved drugs for an FDA approved indication) are covered. Coverage for Compounded Drugs is subject to Prior Authorization by the Plan and Medical Necessity. Refer to the "Off-Label Drugs" provision in the "Prescription Drugs" portion of the "Cov- ered Services and Supplies" section for information about FDA approved drugs for off-label use. Coverage for Compounded Drugs requires the Level IlI Drug Copayment and is subject to Prior Authorization by the Plan and Medical Necessity. Devices Coverage is limited to vaginal contraceptive devices, peak flow meters, spacer inhalers and those devices listed under the "Diabetic Drugs and Supplies" provision of the "Prescription Drugs" portion of "Covered Services and Supplies." No other devices are covered even if prescribed by a Member Physician. Diagnostic Drugs Drugs used for diagnostic purposes are not covered. Diagnostic drugs are covered under the medical benefit when Medically Necessary. Dietary or Nutritional Supplements Drugs used as dietary or nutritional supplements, including vitamins and herbal remedies, including when in combination with a prescription drug product, are limited to drugs that are listed in the Recommended Drug List. Phenylketonuria (PKU) treatment is covered under the medical benefit (see the "Phenylketonuria" portion of the "Covered Services and Supplies" section). Drugs Prescribed for the Common Cold Drugs prescribed to shorten the duration of the common cold are not covered. Drugs Prescribed by a Dentist Drugs prescribed for routine dental treatment are not covered.
