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post in: Products, Lifestyle, Video Date:06 Oct 2017, 17:18 views:4301
Subject: Compounded Drug Products, policy: Certain compounds would not be covered. . Below list reasons why a compound would not be covered:. .
Any drug coded as a pharmaceutical aid, such as bulk powders. .
Any drug coded as OTCs, in the absence of a published Aetna Clinical Policy Bulletin to the contrary, compounded drug products are considered medically necessary. ALL of the following criteria are met: The product contains at least one prescription ingredient.
AND, atlanta the prescription ingredient is FDA-approved for medical use in the United States. AND, the compounded product is not a copy of commercially available FDA-approved drug product. AND, the safety and effectiveness of use for the prescribed indication is supported by FDA-approval or adequate medical and scientific evidence in the medical literature.
Note : Medical and scientific evidence is defined as any one of the following:. Peer-reviewed scientific studies published in or accepted for publication by medical journals that meet nationally recognized requirements for scientific manuscripts and that submit most of their published articles for review by experts who are not part of the editorial staff.
Peer-reviewed literature, biomedical compendia, and other medical literature that meet the criteria of the National Institute of Health's National Library of Medicine for indexing in index Medicus, Excerpta Medicus (embase Medline, or medlars database Health Services Technology Assessment Research (star). Medical journals recognized by the Secretary of Health and Human Services, under Section 1861(t 2) of the Social Security Act (42.S.C.
The following standard reference compendia: DrugPoints System, American Hospital Formulary Service Drug Information (ahfs-DI MicroMedexs DrugDex, Clinical Pharmacology, and National Comprehensive Cancer Network (nccn) Drug Biological Compendia. .
Findings, studies, or research conducted by or under the auspices of federal government best agencies and nationally recognized federal research institutes including the: Agency for Healthcare Research and Quality, National Institutes of Health, National Cancer Institute, National Academy of Sciences, Center for Medicare and Medicaid Services. Any national board recognized by the National Institutes of Health for the purpose of evaluating the medical value of health services.