Pharmacy Benefact - Blue Cross

1 Number 480 September 2014 Compound PINs reference guideTo enhance the efficiency of claims adjudication, all compounds submitted to Alberta Blue Cross should be dispensed using one of the compound PINs listed in the following tables. The PINs assist in the categorization of compound products based on therapeutic drug classification and in the identification of compound products prepared and dispensed by a community PINs to be used when submitting claims for compounds prepared and dispensed by a licensed community Pharmacy :PINC ompound descriptionCompound example Compound Source00999102 Compound - Diclofenac (topical)Diclofenac 2% in PLO GelMade in store00999103 Compound - Anti-Infective (topical)Fusidic Acid 2% and Terbinafine 2% cream - equal partsMade in store00999104 Compound - Salicylic Acid (topical)Salicylic Acid 40% in Petroleum JellyMade in store00999105 Compound - Non-Steroidal Anti- Inflammatories, and/or analgesics, and/or muscle relaxants (other than Diclofenac -Topical)Ketoprofen 10% in PLO GelMade in store00999107 Compound - Corticosteroids (topical)Fluocinonide topical ointment in coal tarMade in store00999108 Compound Narcotic mixtures (oral and injection)Meperidine 10 mg/ml oral solutionMade in store00999109 Compound - Chlorhexidine mouth rinse (in any concentration other than ) (oral)

2 Chlorhexidine in glycerin and distilled waterMade in store00999110 Combination anti-infective/ corticosteroid (topical)Hydrocortisone 1% cream and Mupirocin cream - equal partsMade in store00999111 Compound - Hormones ( estrogen, progesterone, testosterone) (all routes)Progesterone in Van Pen CreamMade in store00999112 Compound - Miscellaneous TopicalDiltiazem 2% in Petroleum JellyMade in store00999113 Compound - Miscellaneous OralPropranolol HCL 1 mg/ml oral suspensionMade in store00999114 Compound - Miscellaneous InjectableErgocalciferol 500,000 IU/ml InjectionMade in store00999119 Compound - Retinoic acid (tretinoin) (topical)Retinoic Acid , Hydrocortisone 1% in Glaxal BaseMade in store00999999 Compound - MiscellaneousDimenhydrinate, Metoclopramide, Prochlorperizine SuppositoriesMade in storePharmacy BenefactA BulletIN for Pharmacy ServICe ProvIderS froM AlBertA Blue CroSScontinued on next page .. continued from previous pageCompound PINs to be used when submitting claims for compounds dispensed by a licensed community Pharmacy and purchased from a licensed compounding and repackaging Pharmacy .

3 PINC ompound descriptionCompound example Compound Source00999202 Compound - Diclofenac (topical)Diclofenac 2% in PLO GelPurchased00999203 Compound - Anti-Infective (topical)Fusidic Acid 2% and Terbinafine 2% cream - equal partsPurchased00999204 Compound - Salicylic Acid (topical)Salicylic Acid 40% in Petroleum JellyPurchased00999205 Compound - Non-Steroidal Anti- Inflammatories, and/or analgesics, and/or muscle relaxants (other than Diclofenac -Topical)Ketoprofen 10% in PLO GelPurchased00999207 Compound - Corticosteroids (topical)Fluocinonide topical ointment in coal tarPurchased00999208 Compound Narcotic mixtures (oral and injection)Meperidine 10 mg/ml oral solutionPurchased00999209 Compound - Chlorhexidine mouth rinse (in any concentration other than ) (oral)Chlorhexidine in glycerin and distilled waterPurchased00999211 Combination Anti-Infective/ Corticosteroid (topical)Hydrocortisone 1% cream and Mupirocin cream - equal partsPurchased00999212 Compound - Hormones ( estrogen, progesterone, testosterone) (all routes)Progesterone in Van Pen CreamPurchased00999213 Compound - Miscellaneous TopicalDiltiazem 2% in Petroleum JellyPurchased00999214 Compound - Miscellaneous OralPropranolol HCL 1 mg/ml oral suspensionPurchased00999215 Compound - Miscellaneous InjectableErgocalciferol 500,000 IU/ml InjectionPurchased00999219 Compound - Retinoic acid (tretinoin) (topical)Retinoic Acid , Hydrocortisone 1% in Glaxal BasePurchased00999216 Compound - MiscellaneousDimenhydrinate, Metoclopramide, Prochlorperizine SuppositoriesPurchasedPlease note: Compounds shown are used for example purposes only and do not confirm eligibility under any plans administered by Alberta Blue contact us should you require assistance in determining compound eligibility or for any compound inquiries.

4 Our representatives will be happy to assist you have questions:For assistance with benefit or claim inquiries, please contact an Alberta Blue Cross Pharmacy Services Provider Relations call centre representative at:780-498-8370 (Edmonton and area) 403-294-4041 (Calgary and area) 1-800-361-9632 (toll free) fAX 780-498-8406 (Edmonton and area) fAX 1-877-305-9911 (toll free) The Blue Cross symbol and name are registered marks of the Canadian Association of Blue Cross Plans, an association of independent Blue Cross plans. Licensed to ABC Benefits Corporation for use in operating the Alberta Blue Cross Plan. ABC 2014/09