APC: Foot-dragging by Tricare/ESI on recoupment refunds

May 7, 2021

Foot-dragging by Tricare/ESI on recoupment refunds

Remember last year’s Tricare/ESI recoupment attempt – in which the agency tried to recoup funds on compounding claims from 2015 from about 400 compounding pharmacies, but then reversed course when challenged by APC and NCPA? And remember how Tricare indicated that funds it recouped would be returned to affected pharmacies who appealed the action?

Yeah, well, now it’s been six months, and for many of those pharmacies that filed the proper appeal paperwork, their funds have not yet been returned.

This week, NCPA’s Ronna Hauser, on behalf of NCPA and APC, reached out to Tricare leaders to express concern about ESI’s dithering in returning pharmacy funds as promised, and reminding the agency that in some cases, more than $100,000 was taken from individual pharmacies and is being held without due process. Came the reply that Tricare is looking into the situation and will get back to us.

So for now we wait. Some more.

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