Some Important Information about Insurance!
Most insurances pay for compounded prescriptions. Apothecary Options will provide you with a detailed and completed universal claim form, and any other required documentation, which you can submit to your insurance company for reimbursement. We estimate that > 80% of our patients receive reimbursement for submitted claims. Apothecary Options does not bill insurance companies directly.
Apothecary Options is a professional compounding pharmacy. We do not dispense regular prescriptions. We specialize in the preparation of unique dosage forms and drug delivery systems that are not commercially available. Our pharmacists have received special training and advanced coursework in compounding. We only use FDA-approved ingredients, which we purchase directly from four major FDA-licensed national suppliers.
For regular prescriptions, insurance reimbursement is based on a universally recognized NDC (National Drug Code) number. All drug manufacturers are required to register and list their drug products with the Food and Drug Administration. The product is then assigned a NDC number. This 11-digit number identifies the manufacturer, the name of the product, and the package size. The number is unique for every drug product. When a pharmacist dispenses a prescription, the cost of producing the product including all the manufacturing and packaging costs is already incorporated into the price that the pharmacy pays for the medication. When a prescription is filled, the insurance company pays the pharmacy a dispensing fee over and above the cost of the drug based on the NDC number. For regular prescriptions, claim submission is done electronically. The pharmacy enters the patient information into their computer along with the drug's NDC number and quantity to be dispensed. Within moments the pharmacy receives an electronic confirmation that the claim is either paid or rejected.
Compounded prescriptions are different than regular prescriptions. At Apothecary Options, we frequently prepare customized formulations that have three or more active ingredients and maybe a half-dozen or more inactive ingredients. Sometimes the "inactive" ingredients are just as expensive as the active ingredients. Because we use FDA approved ingredients, each individual ingredient in our formulas has a NDC number. Current electronic claim standards only allow the submission of a single NDC number for the entire prescription. If we make a product that contains ten ingredients and the insurance company only reimburses us based on one ingredient, who pays for the other nine ingredients? Compounded prescriptions containing multiple ingredients cannot be billed electronically. However, paper claims submitted by patients directly to their insurance company are frequently paid. Paper claims are not processed electronically, they are actually reviewed by a real person at the insurance company who can see a list of all the ingredients and then determine the appropriate amount of reimbursement.
One final word -- When a pharmacy signs a participation agreement with an insurance company, the pharmacy agrees to accept whatever reimbursement the insurance company is offering, for the range of services the pharmacy normally provides. Note: Many pharmacies do not offering compounding services and so this section does not apply to them. However, if a pharmacy routinely dispenses both compounded and regular prescriptions, it is unlawful under most contracts for that pharmacy to accept your insurance and co-pays for your regular prescriptions, but then turn around and refuse your insurance and charge you an out-of-pocket price for a compounded prescription. The pharmacy is not allowed to pick and choose which part of the participation agreement they intend to honor. If this is happening to you, call your insurance company and speak with a pharmacy benefits manager. They can help you determine if the pharmacy in question is violating the terms of their contract.
We are committed to providing our clients with products of uncompromising quality at competitive prices.
Thank you for choosing Apothecary Options!