Compounded Prescription PINs

Before submitting requests for PharmaCare coverage of ANY compound, pharmacists must ensure that the request complies with the Compounded Prescriptions Policy as laid out in the PharmaCare Policy Manual, section 5.13. Any amounts paid out by PharmaCare for compounds that do not comply with this policy are subject to recovery.

On this page:

Press Ctrl+F to search a table for a compound. For exceptional coverage of a compound not listed here, please refer to the PharmaCare Policy Manual, section 5.13, Special Authority for non-benefit compounds.

All compounds—whether a PharmaCare benefit or not—must be submitted in PharmaNet using the appropriate PIN.

If you are unsure which PIN to use for the prescribed compound or if the patient meets criteria, please contact the PharmaNet HelpDesk before submitting the claim on PharmaNet.


Compounding fee schedule

The table below establishes maximum fees for both eligible compounds and for compounds approved via Special Authority. The inclusion of a fee for a particular type of compound in the schedule below, therefore, does not necessarily confer coverage.

The table below establishes maximum fees for both benefit compounds and for compounds approved via Special Authority, which would otherwise be a non-benefit. The inclusion of a fee for a particular type of compound in the schedule below, therefore, does not necessarily confer benefit status. 

Compounding fee schedule
Compound Maximum Allowable Compounding Fee
Oral solutions $20.00
Oral suspensions $20.00
Capsules $0.30 per capsule
Suppositories $40.00 for a minimum 10-day supply. Prescriptions for less than 10-day supply are prorated to maximum $4.00 per day.
Oral lozenges $40.00 for a minimum 10-day supply. Prescriptions for less than 10-day supply are prorated to maximum $4.00 per day.
CADD injections $20.00
Sterile IV, IM, SC injections $20.00
Intrathecal injections $40.00
Creams/ointments/lotions < or = 250 g/mL $15.00
Creams/ointments/lotions > or = 251 g/mL $20.00
Sterile eye drops, preservative free $30.00

Eligible PINs

All eligible compound PINs have criteria. Additionally, compounds containing active ingredients that are subject to Special Authority will require Special Authority approval.

Eligible PINs index:

Oral suspensions

The maximum compounding fee for oral suspensions is $20 per compound. For the list of eligible bases, see below this table.

 
Oral suspensions Compound Criteria Special Authority Required PIN
acetazolamide Yes No 22123223
allopurinol Yes No 22123307
alprazolam Yes No 22123308
amiloride Yes No 22123309
amiodarone Yes No 22123310
amitriptyline Yes No 22123224
amlodipine Yes No 22123311
aripiprazole Yes Yes 22123272
atenolol Yes No 22123225
azathioprine Yes No 22123236
baclofen Yes No 22123226
bisoprolol Yes No 22123227
captopril Yes No 22123228
carvedilol Yes Yes, except for Plan P 22123265
cisapride Yes Yes 22123195
citalopram Yes No 22123229
clobazam Yes No 22123230
clonazepam Yes No 22123231
clonidine Yes No 22123232
clozapine Yes No 22123233
cyclobenzaprine Yes No 22123234
dantrolene Yes No 22123235
diazepam Yes No 22123237
domperidone Yes No 22123238
enalapril Yes No 22123239
escitalopram Yes No 22123240
esomeprazole Yes Yes 22123271
felodipine Yes No 22123241
folic acid Yes No 22123242
gabapentin Yes Yes, only for Plan G 22123243
glycopyrrolate Yes No 22123302
griseofulvin Yes No 22123244
hydrochlorothiazide Yes No 22123245
hydroxyurea Yes Yes, only for Plan G 22123270
hyoscine Yes No 22123298
labetalol Yes No 22123312
lamotrigine Yes No 22123246
lansoprazole Yes Yes 22123269
leflunomide Yes Yes 22123273
levetiracetam Yes Yes 22123267
levo-thyroxine Yes No 22123247
lisinopril Yes No 22123313
lorazepam Yes No 22123248
methylphenidate Yes No 22123249
metoprolol Yes No 22123250
metronidazole Yes No 22123251
nitrazepam Yes No 22123314
nitrofurantoin Yes No 22123252
nortriptyline Yes No 22123253
omeprazole Yes Yes 22123268
oxazepam Yes No 22123254
pantoprazole sod Yes Yes 22123315
paroxetine Yes No 22123255
propranolol Yes No 22123316
quetiapine Yes No 22123257
ramipril Yes No 22123256
rifampin Yes No 22123317
sertraline Yes No 22123258
sildenafil Yes Yes 22123318
sotalol Yes No 22123259
spironolactone Yes No 22123260
sulfasalazine Yes No 22123261
tacrolimus Yes No 22123266
temazepam Yes No 22123262
topiramate Yes No 22123319
trazodone Yes No 22123263
ursodiol Yes No 22123264
vancomycin Yes Yes 22123320
zopiclone Yes Yes 22123274

Eligible bases for compounded oral suspensions

Eligible bases for compounded oral suspensions include—but are not limited to—the following:

  • *fixed oil suspension
  • *methylcellulose 1% gel
  • *methylcellulose suspension
  • Ora Blend® (regular and SF) or equivalent
  • Ora Sweet® (regular and SF) or equivalent
  • oral base SF
  • oral mix (regular and SF)
  • oral mix dry alka SF
  • oral suspend
  • oral syrup (regular and SF)
  • *simple syrup
  • sodium bicarbonate stock solution (not commercial injection)
  • *sorbitol solution USP 70%
  • syrup (flavored, oral vehicle)
  • syrup SF (flavored, oral SF vehicle)
  • water (demineralized, distilled, *preserved or purified)

SF = sugar-free

* = either in-store made (stock solution) or commercially available product

If a vehicle or base is not listed above, please contact the PharmaNet Help Desk to determine whether the base is eligible for coverage before submitting a claim.

Note: Stock solutions are not eligible for a separate compound fee. Please see Maximum Allowable Costs and Fees, Stock Solutions.

Dermatologicals

Dermatological compounds may be processed under a PIN from the table below only if

  • It does not duplicate a commercial product
  • The eligible active ingredient(s) are compounded into an eligible medicated or non-medicated base. Compounds in transdermal bases are not an eligible PharmaCare benefit. For eligible bases, see list below this table
  • The compound criteria have been met
  • If any active ingredient requires Special Authority and an approval has been granted  

Topical antifungals and retinoic acid also require a current Special Authority for the active ingredient, with the exception of an eligible topical antifungal for a Palliative Care registered patient (Plan P).

The maximum compounding fee for dermatologicals is $15 up to 250 gm/mL, and $20 over 250 gm/mL.

 
Dermatologicals Compound Criteria Special Authority Required PIN
anthralin + salicyclic acid ointment (psoriasis/eczema) Yes No 22123277
clindamycin in medicated/non-medicated benefit base Yes No 22123280
coal tar/LCD in medicated/non-medicated benefit base Yes No 22123305
corticosteroid in non-medicated benefit base Yes No 22123283
corticosteroid in medicated benefit base Yes No 22123303
corticosteroid + antifungal in benefit base Yes Yes, except for Plan P 22123286
corticosteroid with at least one of the following: menthol, camphor, urea topical compound Yes No 22123278
erythromycin in medicated/non-medicated benefit base Yes No 22123279
metronidazole in medicated/non-medicated benefit base Yes No 22123281
retinoic acid in medicated/non-medicated benefit base Yes Yes 22123304
salicyclic acid ointment/cream (psoriasis/eczema) Yes No 22123284
salicyclic acid + corticosteroid ointment/cream (psoriasis/eczema) Yes No 22123285
sulfur/sulfacetamide in medicated benefit base Yes No 22123282
urea (only in combination with at least one prescription benefit ingredient) Yes No 22123337

 Eligible bases for compounded dermatologicals

 Eligible non-medicated bases include—but are not limited to—the following:

  • Aquaphor™
  • Aveeno® cream or lotion (SPF-free and not anti-itch or anti-aging)
  • Barriere™ cream
  • Cetaphil® cream or lotion
  • Cera-Ve® cream, lotion or ointment (SPF-free)
  • Cliniderm™ cream or lotion
  • cold cream
  • Complex 15™ cream or lotion
  • Dermabase™
  • Dilusol™
  • Dormer™ cream or lotion (SPF-free)
  • Duonalc™
  • emollient cream
  • emulsifying ointment
  • Eucerin™ anhydrous, cream, lotion or ointment (SPF-free and not anti-aging)
  • Glaxal Base™ 
  • Glysomed® cream or lotion
  • hydrophilic petrolatum or hydrophilic petrolatum 25% water (aqueous)
  • Intrasite Gel™
  • lanolin
  • Lubriderm® (SPF-free)
  • Medi-Derm™ cream base
  • mineral oil
  • Neutrogena® (SPF-free and not T/gel, sunscreen or anti-aging)
  • Spectro® cream
  • Spectro Jel™ (cleaner and blemish-prone cleanser)
  • urea cream or lotion (including Urisec®)
  • vanishing cream
  • Vaseline™ jelly
  • zinc oxide (SPF-free) topical cream or ointment (including Desitin®, Ihle's Paste, Infazinc® and Zincofax®)

For more information about eligible bases, please contact the PharmaNet Help Desk. 

Mouth rinses

 
Mouth Rinses Special Authority Required PIN
corticosteroid with nystatin, diphenhydramine and tetracycline Yes, except for Plan P registered patients 22123332
corticosteroid with nystatin, diphenhydramine, tetracycline and lidocaine Yes, except for Plan P registered patients 22123333
corticosteroid with nystatin and diphenhydramine Yes, except for Plan P registered patients or prescriptions written by an exempted prescriber. 22123334
corticosteroid with nystatin and lidocaine, with or without glycerin Yes, except for Plan P registered patients 22123335

Intrathecal analgesics—palliative

Repackaging a prescribed benefit injectable analgesic, or a Special Authority approved medication for intrathecal administration is only a benefit compound under a PIN from the table below when a patient is registered under the PharmaCare Palliative Care Drug Plan (Plan P).

 
Intrathecal Analgesics—Palliative Compound Criteria Special Authority Required PIN
narcotic Yes No 22123299
non-narcotic Yes No 22123300
narcotic and non-narcotic Yes No 22123301

CADD injections—palliative

Repackaging a prescribed injectable benefit analgesic into a continuous ambulatory delivery device (CADD) pump is only a benefit compound under a PIN from the table below when a patient is registered under the PharmaCare Palliative Care Drug Plan (Plan P).

 
CADD Injections—Palliative Compound Criteria Special Authority Required PIN
non-narcotic Yes No 22123287
narcotic Yes No 22123288
controlled Yes No 22123371

Medical assistance in dying (MAiD)

 
Medical Assistance in Dying (MAiD) Special Authority Required PIN
phenobarbital/chloral hydrate/morphine sulphate suspension No 88000002
secobarbital suspension No 88000003

Preservative-free eyedrops

Preservative-free sterile eye drops may only be processed under a PIN from the table below when an ophthalmologist has documented the patient’s allergy to specified preservative(s) in commercially available eye drops on the compound prescription.

The maximum compounding fee for eye drops is $30.

 
Preservative-Free Eyedrops Compound Criteria Special Authority Required PIN
acetylcysteine Yes No 22123289
amphotericin Yes No 22123290
cefazolin Yes No 22123291
ceftazidime Yes No 22123292
gentamicin Yes No 22123293
pilocarpine Yes No 22123294
timolol Yes No 22123295
tobramycin Yes No 22123296
vancomycin Yes No 22123297

Other compounds

 
Other Compounds Special Authority Required PIN
disulfiram 125 mg capsule No 66124089
disulfiram 250 mg capsule No 66124085
disulfiram 500 mg capsule No 66124087
prostaglandin injection Yes 66123910
papaverine in combination with phentolamine OR prostaglandin in combination with papaverine or phentolamine (BiMix) injection Yes 66123495
prostaglandin in combination with papaverine and phentolamine (TriMix) injection Yes 66123483
saturated potassium iodide solution No 999113

Non-benefit PINs

For all non-benefit compounds, use the appropriate PINs in the table below.

If you are unsure whether a compound may be processed under an eligible PIN, please contact the PharmaNet HelpDesk before submitting the claim on PharmaNet.

 
Non-Benefit Compounds PIN
compound preparations (non-benefit) 66123252
controlled compound (non-benefit) 66124162
narcotic compound (non-benefit) 66123367
topical anti-fungal compounded (non-benefit) 66124164
hormone injection compound (non-benefit) 66128214
hormone injection controlled compound (non-benefit) 66128215
hormone oral compound (non-benefit) 66128216
hormone oral controlled compound (non-benefit) 66128217
hormone topical compound (non-benefit) 66128218
hormone topical controlled compound (non-benefit) 66128219
NSAID Topical compound (non-benefit) 66128220
medicinal alcohol (non-benefit) 66123239
APNO (mupirocin 2%, betamethasone 0.1%, miconazole 2% in ointment base) 22123354

Discontinued compound PINs

PharmaNet records show the following PINs are still being utilized to submit compound claims. Please refer to the Compounded Prescriptions Policy for eligibility requirements and the eligible PIN list for a suitable replacement.

If there isn’t an eligible PIN for the compound being prepared (where the patient meets the compound criteria) and there is no suitable non-benefit PIN from the table above, please contact the PharmaNet HelpDesk.

 
Discontinued Compounds PIN
narcotic compound (non-benefit) 999776
compounded lotion 842443
compounded ointment/cream 842435
compounded mixture 921297