Medical Insurance Won't Cover A Medication. Can I Get In Any Trouble Using An Out Of Pocket Workaround With A Compounding Pharmacy?
I've been trying to lose weight for a long time and my primary care physician recently tried writing me a prescription for Zepbound. My insurance wouldn't cover it. When I called to see if there was a different drug they preferred, I learned that all weight loss drugs are "plan exclusions" (i.e. not covered).
I have recently come into possession of the name/number for a nearby compounding pharmacy. I was basically told that if I go see them, they'll point me to a nearby doctor who will just write me a prescription for compounded Tirzepatide as long as I explain that I have a PCP who is trying to get me on it and my insurance won't cover it. Then I can get it from the compounding pharmacy for significantly less than a regular pharmacy (like 1/5th the price).
This doesn't necessarily feel illegal since I would be handling it all out of pocket and not involving the insurance company at all, but it definitely feels like it's not the way you're supposed to go about getting the drug. Is there any chance I could get in any sort of trouble for doing it through the compounding pharmacy?
Location: Texas
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