Tricare to stop recoupments on compounded meds

Thursday, October 22, 2020

ALEXANDRIA, Va. – TriCare/Express Scripts will no longer seek to recoup prescriptions from compounding pharmacies from 2015 that it says were fraudulent because there was no physician/patient relationship indicated. The amounts to be recouped ranged from less than $100 to more than $200,000. “ESI was basically saying that the only way the pharmacies could exonerate themselves was by producing documentation that the prescribing physician actually had seen the patient,” said Scott Brunner, CEO of the Alliance for Pharmacy Compounding. “That’s documentation that no state in the nation requires pharmacists to maintain.” Both APC and the National Community Pharmacists Association also say that ESI’s communication to pharmacies about the recoupment was incorrectly dated and full of errors about the claims they were seeking to recoup. They took their concerns to the Defense Health Agency, which oversees Tricare. In response, Tricare has instructed ESI to stop the recoupments it started in June. Pharmacies that have already suffered clawbacks will be allowed to appeal and the standard for documentation of those appeals will now be reasonable.