Supplements & Prescriptions

March 13th, 2011

Buying Supplements and Non-Insurance Covered Meds

Over the years, I have seen many people be successful getting their insurance companies to cover compounded vitamins. But there are tricks to being successful.

  • Make sure your insurance plan doesn’t exclude vitamins and supplements before you start.
  • If your child has a diagnosis of a disorder/disease that is shown to be treated with a particular vitamin (that has an NDC#) and that vitamin is in your mixture, you should be able to get it covered.
  • If your child has an allergy to an ingredient in the standard OTC vitamin mixture, you might be able to get it covered.
  • NDC (National Drug Code)

 

Prescriptions

  • Some insurers cover generic over non-generic at a higher rate of reimbursement and some will EXCLUDE the non-generic.  You can ABSOLUTELY appeal a rejection of a non-generic if your doctor writes a letter of necessity and states why the non-generic is mandatory.
  • There are a lot of great compounding pharmacies that serve the autism community, but you need to find out if your insurance-covered compounding pharmacy will make it before you pay out of pocket just because your doctor recommends a particular pharmacy.
  • Have your local pediatrician rewrite the autism-specialist’s prescriptions so your insurance (and Medicaid) will cover them.

Using a Compounding Pharmacy

Insurance companies offer compounding through either their in-house pharmacy or retail compounders, but here is a tip: most charge by the FILL, not by the month. And they likely max out at 90 days, so any script written for longer will be rejected. There can be any number of refills, that makes no difference. Call your prescription plan and ask how they fill and bill to see if this applies to you.

Let’s say for example, your child is to take one 5mg pill per day.

  • If your script says “one 5mg pill per day for 30 days”, they will charge you $30 times 12 ($360 a year.)
  • If the script says “one 5mg pill per day for 90 days”, it’s still $30, for a 90-day supply. With 4 refills, this will cost you $120 a year.
  • If the script is written for a year’s worth (i.e. one 5mg pill, four times a day for 90 days), they will charge you $30 (even though it’s twelve months worth of meds) per year.

If you cannot get your vitamins and supplements covered TACA has an overview of supplements that can help you.

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