ARTA Compound Prescription Coverage

What is a compound prescription?

Most commercially available prescription medications are made in large scale pharmaceutical manufacturing facilities. These products provide wide-scale access to safe and effective medications. Their quality assurance is under rigorous regulations and oversite of Health Canada and other international regulatory bodies.

A compound medication is the mixing of two or more ingredients, at least one of which is a prescription drug. Unlike commercially available medications, compounds are usually made at a local pharmacy.

Compounding facilities are regulated by provincial colleges of pharmacy. The Alberta College of Pharmacy establishes standards to protect the public, but these are less extensive than those required by commercial manufacturing.

Compounded medications are intended to meet an individual’s unique needs that are not met by commercially available products. Compounded medications typically alter the strength, route of administration (topical, oral, rectal, vaginal, injection, etc.) or effect of a commercially available drug.

For example, if someone has difficulty swallowing large tablets, a compound may be created by crushing the commercial tablets and reformulating them into an oral liquid for ease of administration.

In the past, many claims for compounds have been submitted, many lacking proof of effectiveness with no corresponding improvement in the quality of care. Reviewing evidence of compounded prescription drugs ensures we have policies and practices in place to provide plan members with access to the appropriate level of health care at all times.

What kinds of compound prescriptions are covered by my benefits?

The ARTA Retiree Benefits Plan covers many instances of compound drugs. In these instances, the ingredients are deemed to be safe, the indicated use is approved by Health Canada, and a commercially available alternative is not available.

Compounds must contain an active eligible ingredient in a therapeutic concentration in an eligible base for it to be a benefit covered under your drug plan.

Topical Compounds

Topical (applied to the skin) compounds made by combining two or more commercially available prescriptions creams or ointments are eligible for coverage.

Topical compounds may include one of the eligible ingredients and bases from the table above if each component is compounded in an approved manner. Any one or more of the eligible ingredients may be combined with any of the eligible bases. Any one or more of the eligible ingredients may also be combined with a commercially available drug product that is already covered by your plan.

Lastly, to be eligible for coverage, compound prescriptions must contain an active ingredient in a concentration that is considered therapeutic in a manner approved by your plan.

Topical Non-Steroidal Anti-Inflammatory (NSAID) Compounds

Topical Non-Steroidal Anti-Inflammatory (NSAID) compounds are a benefit under the ARTA Retiree Benefits Plan. These compounds must only contain the NSAID as the active ingredient with a topical base. NSAIDs that may be considered include diclofenac and ketoprofen.

What kinds of compound prescriptions are NOT covered by my benefits?

Compound prescriptions are not covered by your benefits if they are deemed experimental, for cosmetic purpose, or if there are existing commercial pharmaceutical alternatives available.

The following compounds are not eligible for coverage under the ARTA Retiree Benefits Plan:

• Compounds created for cosmetic purposes (including treatments for baldness, dry skin, and facial wrinkles).
• Compounds which duplicate the effect of an existing pharmaceutical product.
  • Example: Hydrocortisone powder into Glaxal base. This duplicates other commercially available hydrocortisone cream products.
• Compounds with unproven effects or compounds otherwise not approved by Health Canada.
  • Compounds that contain a commercial product (Drug Identification Number – DIN) approved for one route of administration being used as an ingredient with a different route of administration.
    • Example: Compound contains DIN for an injectable product, and the user intends to ingest the compound orally.
      • This is different from the above eligible example of crushing an oral tablet, which would be administered in an oral liquid.
• Orally administered compounds which contain a pure, raw chemical ingredient.
• Compound prescriptions for “Triple P” therapy which use Prostin VR. Erectile dysfunction is not an approved use for this product. Claims of this nature must use alprostadil powder or Caverject to be considered for coverage.

Your pharmacy provider can call Green Shield Canada representatives to ensure compound eligibility prior to dispensing your compound. If a compound is not verified prior to direct billing, and is later deemed ineligible after audit, your pharmacy may not be paid, and you may incur an out-of-pocket expense.