If you’ve ever received a compounded medication or are considering one, you may be wondering if your private health insurance will cover it. The good news is that in many cases, partial reimbursement is possible. However, there are a few steps you’ll need to take to find out what your insurer will and won’t cover.
This fact sheet explores the following:
- Check Your Policy First
- Partial Reimbursements May Apply
- Ask Us for a Quote First
- Customised Medicines vs Mass-Produced Drugs
- It’s Always Worth Asking
- Video Transcript
Check Your Policy First
At National Custom Compounding, every time you receive a compounded medicine, you’ll also receive a private medicine receipt. This is essential when it comes to making a claim with your health insurer. However, because we don’t have direct contact with every insurance provider, it’s important for patients to take the first step.
We recommend checking your insurance policy or logging into your insurer’s app to see if compounded or private medicines are eligible for coverage. A quick call or chat with your insurance provider can also clear up any confusion.
Partial Reimbursements May Apply
Just like with traditional pharmacies where you might pay more than the standard price for a particular medicine and then claim part of that cost back from your insurer, similar arrangements can often be made for compounded medications.
While your health insurer may not reimburse the full amount of a compounded prescription, they may cover a portion of the cost, reducing your out-of-pocket expense.
Ask Us for a Quote First
If you’re unsure whether your health fund will reimburse a compounded medicine, we can help make the process easier. Simply contact us at National Custom Compounding and we’ll provide you with a clear quote upfront. You can then use this quote when you talk to your insurance provider, helping you determine your potential coverage before committing to the medication.
Customised Medicines vs Mass-Produced Drugs
It’s also helpful to remember that there is a fundamental difference between what you receive from a compounding pharmacy versus a traditional pharmacy. Compounded medicines are tailor-made for your individual needs, created on demand, whereas commercial pharmacies dispense mass-produced medications from pharmaceutical manufacturers.
Because of this, the price point may differ. However, the value lies in the personalised care and precise formulation you receive with compounding.
It’s Always Worth Asking
Health insurance coverage for compounded medicine isn’t guaranteed, but you won’t know unless you ask. Our team is always happy to assist, provide documentation, or supply a quote to help you navigate the process. Whether you’re a new patient or someone who’s used compounded medications before, checking your insurance coverage can potentially save you money.
This article was written by Matt Bellgrove, Managing Director & Compounding Pharmacist
Video Transcript
So the first thing to look at is your own insurance policy. At National Custom Compounding, we always provide you with a private medicine receipt each time you get compounded medications from us. But we’re not in touch with all the insurers always, so we do need you—as the first step—just to have a look at your insurance policy, bring up your app, or chat to your insurer provider, and they’ll be able to tell you whether private medicines and/or compounding medicines are available under your insurance policy.
Some insurers may reimburse some of the costs. You might be familiar with walking into your normal pharmacy and paying more than the typical price, but the insurer covering that gap. That’s exactly the same thing that can happen with compounding pharmacies. So, compounding pharmacies that make a medicine for price X might be… the insurer might give you a portion of that back—while not the whole thing—just to make it a little bit cheaper.
So again, chat to your insurance provider.
And the other thing is, if you’re unsure about whether your provider does or does not cover it, why not give us a call? We’re more than happy to provide you with a quote before you go ahead with anything, and that’ll just give you the certainty when you then talk to your insurer about whether it’s cheaper or not… about whether they’re going to cover it.
So there’s a few options and a few ways to approach us, but we’ll always give you a receipt. We always encourage patients to always talk to their insurer because you don’t know unless you ask the question.
And again, although compounding medicine might be a slightly different price to what you’re used to in a regular pharmacy, keep in mind that they’re comparing two different things. So, we’ll make a custom medicine just for you, just when you need it—compared to a regular pharmacy, which uses mass-produced drugs from drug company manufacturers.
So it’s not always guaranteed, but worth asking about your insurer. Chat to us if you’d like a quote. We’re always happy to help.
