Primary Purpose: Treatment: Official Title: Vaginal Estradiol vs Oral Beta-3 Agonist for Treatment of Overactive Bladder Syndrome: A Single-Therapy, Double-Blind, Randomized Controlled. Providers are required to maintain documentation demonstrating that the commercially available product was on back-order at the time of dispense.įor additional information regarding extemporaneous mixtures, please refer to NIHB's Guide for Pharmacy Benefits. The vaginal cream placebo (Mediscas VersaPro Cream Base) and active medication will be placed in jars and have similar color, smell, and consistency. The claim must be submitted using the corresponding miscellaneous pseudo-DIN. Back Order Items and Compounding: Providers who are preparing a compound to replace a commercially available product which is on back-order do not require a PA. These powders must be billed at AAC and must not exceed the maximum allowable AAC which is based on the price of the DIN of the comparable listed tablet or capsule. Pharmaceutical powders of eligible ingredients may be used in lieu of tablets/capsules. Mixtures that contain ingredients excluded from the Program will not be eligible for coverage.Īll extemporaneous mixtures must be submitted with the corresponding pseudo-DIN to be reimbursed appropriately. Mixtures that contain exception or limited use drugs must receive prior approval by the DEC. To be eligible under the NIHB Program, extemporaneous mixtures (compounds) must have at least one ingredient listed on the DBL and must not duplicate the formulation of commercially manufactured drug products.
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