This has been a recent trend with insurance companies and compound medicines. They basically don't want to pay for it and think that a percentage of people will never appeal
It is a recent trend, yes. But the trend isn't with insurance companies. It is with the compounding companies themselves. They have been mixing and matching drugs into "compounds" for years, but lately they have been doing it at an alarming unsafe rate. The FDA has issued quite a bit of guidance and actions against the compound companies lately. The insurance companies are just reacting to the market - their policies and actuarial practices take into consideration of individual drugs getting prescribed and paying certain number of claims. The compound drugs, when not medically necessary, are simply compounded to save the consumer money. Say you have 5 drugs a patient needs - typically, that is a claim with a copay for each drug, right? Well, if the patient buys those from a compound company, it potentially saves the patient 4 copays per month. If the copay is $10, that's a savings of $40 per month for the patient, but a loss of revenue for that same amount to the insurance company. The insurance companies count on the copays as income. The patient has actually cheated the insurance company. The problem is, there are still countless times when the compounding is legit -- so who should burden the cost of evaluating each of these cases? The consumer doesn't want to do it. The compound drug providers sure as hell won't do it. So that leaves the insurance companies themselves to do it.
As shitty as it seems, the most practical and lowest impact to the consumer is to reject the majority of the claims based on the NDC's (national drug code) in the compound. If they just pay all compounds that are submitted, ALL consumers will get hit with higher premiums to cover the cost of lost copays. So, really, the best way to handle it all around is the way the are doing. Unfortunately, it does mean that a lot of medical necessity claims are rejected on first pass. FORTUNATELY, the consumer does have the right to an appeals process.