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Accessibility Statement

Compounded prescription PINs

Last updated on April 4, 2024

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

On this page:

Compounding fee schedule
Eligible PINs

Non-benefit PINs
Discontinued compound PINs

Press Ctrl+F to search a table for a compound. For exceptional coverage of a compound not listed here, please refer to the Compounded Prescriptions — Section 5.13, PharmaCare Policy Manual.

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
Dermatologicals
Mouth rinses
Intrathecal compound injections—palliative

CADD injections—palliative
Medical assistance in dying (MAiD)
Preservative-free eyedrops
Other compounds

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
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
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 + antifungal in benefit base	Yes	Yes, except for Plan P	22123286
corticosteroid in medicated benefit base	Yes	No	22123303
corticosteroid in non-medicated benefit base	Yes	No	22123283
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 + corticosteroid ointment/cream (psoriasis/eczema)	Yes	No	22123285
salicyclic acid ointment/cream (psoriasis/eczema)	Yes	No	22123284
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
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
prostaglandin injection	Yes	66123910
quinidine 200 mg capsule*	No	66128429
saturated potassium iodide solution	No	999113

* Coverage is provided for quinidine. Quinidine may be confused with clonidine, quinine.

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
All Purpose Nipple Ointment (APNO ) (mupirocin 2%, betamethasone 0.1%, miconazole 2% in ointment base)	22123354
compound preparations (non-benefit)	66123252
controlled compound (non-benefit)	66124162
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
medicinal alcohol (non-benefit)	66123239
narcotic compound (non-benefit)	66123367
NSAID Topical compound (non-benefit)	66128220
topical anti-fungal compounded (non-benefit)	66124164

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

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