October 15, 2020

Tricare stands down, ESI (gasp!) apologizes

The Tricare recoupment fiasco faced by hundreds of pharmacies across the country appears to be nearing its end, with a victory for pharmacists in sight.

In response to concerns raised by APC and its partners, Tricare has instructed Express Scripts 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.

APC teamed with NCPA and PAAS National to challenge the recoupment, and, over a series of conference calls with Tricare and ESI, were able to demonstrate how the recoupments themselves were often invalid, and the requirements for appeal were egregious (and, frankly, bordered on the absurd).

Attorneys Hunter Jamerson of Macaulay & Jamerson and Jeff Baird and Brad Howard of Brown & Fortunato were instrumental in assisting APC in this recoupment challenge.

Now some pharmacies will even be receiving an apology from ESI.

You’ll find details at A4PC.org/tricareclawbacks, and a video of the APC briefing call is available on Vimeo.