Bulk Powder Compounds: Claim Processing Change, Effective July 1, 2017

Blue Cross and Blue Shield of Oklahoma (BCBSOK) periodically conducts claim reviews to help ensure that we are paying only for services that are covered benefits under our members' and groups' benefit plans, as well as within our claims guidelines and Medical Policies. An increasing number of claims for compounded drug products have been identified that are not covered benefits as they do not meet the limited exception criteria for coverage of compounded drug products formulated from bulk powders under BCBSOK Medical Policy.

Please be advised that, for dates of service on or after July 1, 2017, claims submitted to BCBSOK for compounded drug products using bulk powders will be denied, in accordance with our Medical Policy. As of this effective date, independently contracted BCBSOK providers will receive a message on their Electronic Payment Summary (EPS) or Provider Claim Summary (PCS), as follows:

"Services for Bulk Powder or Compound Drugs are considered experimental, investigational, or unproven and not covered under the member's benefit plan. This is a contracted provider; the member is not responsible for payment of these charges."

Limited Exceptions

In general, compounded drug products using bulk powders are considered to be experimental, investigational and unproven. Bulk powder compound exceptions listed under our Medical Policy are for members that meet coverage criteria for the following:

*Note: Compound drugs using commercially available FDA-approved drugs will continue to be considered for coverage