ALEXANDRIA, Va. – An egregious Tricare/Express Scripts (ESI) recoupment faced by hundreds of compounding pharmacies across the country is ending, thanks to the work of two industry trade associations, the Alliance for Pharmacy Compounding and the National Community Pharmacists Association.
It began back in June, when about 400 compounding pharmacies across the U.S. received a recoupment notice from ESI claiming that Tricare prescriptions from 2015 were fraudulent because there was no physician/patient relationship indicated. The amounts to be recouped ranged from less than $100 for one pharmacy to more than $200,000 for another.
“This wasn’t the usual desk audit,” said NCPA vice president of Policy & Government Affairs Operations Ronna Hauser. “It was an allegation of fraud against the compounders.”
“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,” added APC CEO Scott Brunner. “That’s documentation that no state in the nation requires pharmacists to maintain.”
In addition, Hauser and Brunner noted that ESI’s communication to pharmacies about the recoupment was incorrectly dated and riddled with errors about the claims they were seeking to recoup.
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