Effective January 1, 2015, updates will be made to the AmeriHealth pharmacy policy on compound medications. This policy is reviewed annually by the Pharmacy & Therapeutics Committee to ensure it meets the necessary standards and efficacy.

The U.S. Food and Drug Administration (FDA) defines pharmacy compounding as the practice in which pharmacists combine, mix, or alter ingredients to create unique medications that meet the specific need of an individual patient. Drugs are compounded for patients who have allergic reactions to inactive ingredients in FDA-approved medications or for those patients who require a different formulation of a medication that is not commercially available.

A compounded product is not considered medically necessary when it replicates a commercially available product (unless the commercially available product is temporarily unavailable), contains a drug product or component that has been removed from the market because it is unsafe or not effective, or contains a drug product or component that is excluded from the member's benefit.

Changes to the policy

Some of the key changes to the policy include:

• addition of the following inclusion criterium: the compound is not used for an excluded benefit (e.g., cosmetic);
• addition of authorization requirements;
• updates to applicable products.