Insurance Claim Forms
Compounded prescription medicines are covered by many major insurance plans. In many cases, Village Pharmacy can submit a claim for compounded medicines that are covered by your plan. If not, we can help you complete a request for reimbursement.
Follow the steps below to submit a reimbursement request to your insurance plan.
- When you pick up your compounded medicine, Village Pharmacy will give you a form to send in to your insurance carrier. Our form is approved by the International Academy of Compounding Pharmacists.
- Prior to submitting the form, contact your insurance carrier’s customer service department. They may require their own form in addition to the compounded medicine form that Village Pharmacy provides.
- Fill in your personal information on required form(s). Mail the completed form, along with your paid receipt (and insurance claim form if required), to your prescription insurance carrier.