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PHARMACY COVERAGE GUIDELINES
SECTION:
DRUGSORIGINAL EFFECTIVE DATE:
LAST REVIEW DATE:
LAST CRITERIA REVISION DATE:
ARCHIVE DATE:9/15/16
9/20/18
9/21/17OffLabel Use of NonCancer Medications
Coverage
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Compounded medication - blue is a medication that is customized or tailored to meet the specific needs of a patient, with a blue color added to it for identification purposes.
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Healthcare professionals or pharmacists who prepare or dispense compounded medication - blue are required to file this information.
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To fill out compounded medication - blue, the healthcare professional or pharmacist must document the specific ingredients used, the compounding process, and any relevant patient information.
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The information that must be reported on compounded medication - blue includes the ingredients used, the date of compounding, the prescribing physician, and the patient for whom the medication is intended.
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