Question:
When it comes to drugs and biologicals for inpatients, is coverage limited to those that the hospital routinely stocks?
Answer:
Coverage is not limited to those routinely stocked by the hospital; a drug or biological not stocked by the hospital that is obtained for the patient from an outside source, such as a community pharmacy, also can be covered.
Those not included in the drug list or formulary maintained by the hospital’s pharmacy and drug therapeutics committee may be covered if the hospital has a policy that permits such drugs to be furnished to a patient at the special request of a physician.
However, in order to be covered, such drugs and biologicals must be included or approved for inclusion in one of the designated drug compendia. (In addition, a combination drug or all of its therapeutic ingredients would have to be included or approved for inclusion in one of the compendia.)