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Payors Start Requesting Medical and Scientific Evidence from Physicians Prescribing Compounds: Is Your Referring Physician Prepared?

In the latest trend of compound coverage and reimbursement, certain payors have begun requesting medical and scientific evidence directly from physicians prescribing compounds, as part of their determination as to whether a given prescription should be covered. For some time, certain PBMs have “required” two peer reviewed studies from the billing pharmacy for every ingredient contained within the compound. Conversely, other PBMs have been calling doctors urging them to prescribe...