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Covered Services

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including health, dental, and pharmacy.

Compound Drugs

Compound drugs are:

  • A combination of two or more drugs
  • Prepared by a pharmacist
  • For a patient’s individual needs

Screening Process for Compound Drugs

Step 1: Electronic Screen

Express Scripts screens each ingredient to make sure:

This step usually takes less than 5 seconds to complete.

Step 2: Required if the Compound Doesn’t Pass Step 1

If the compound drug—or any ingredient in it—doesn’t pass the first step, your pharmacist can:

  • Remove the non-covered ingredient or replace it with a covered ingredient.
  • Contact your doctor to request a different drug to treat your condition.

This step happens while you wait at the pharmacy. It may take 15-20 minutes.

Step 3: Prior Authorization

Your doctor can request prior authorization for the compound drug if they can’t substitute an ingredient or prescribe a different drug for you. This allows Express Scripts to individually review your prescription to make sure it's safe, effective and medically necessary.

To request prior authorization:

  • Download or contact Express Scripts to get a Compound Drug Prior Authorization Form 
  • Give it to your doctor to complete and submit to Express Scripts (instructions are on the form)

This step usually takes about 5 days from when Express Scripts gets all the necessary paperwork.

If your compound drug doesn’t get approved, you have 90 days to request a formal appeal.

Last Updated 4/1/2016

contact Your Contacts

Express Scripts, Inc.

Stateside: 1-877-363-1303
Overseas: 1-866-275-4732
(where toll-free service is established)

Express Scripts Website

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