March 4, 2022

APC workgroup hosts call with TRICARE officials

On Thursday, an APC workgroup continued a dialogue begun by the Board of Directors in November with chief of the Pharmacy Operations Division at the Defense Health Agency Colonel Markus Gmehlin, and his team. Chaired by Michelle Moser of Makers Compounding Pharmacy in Mt. Vernon, Wash., the workgroup was appointed by APC Board Chair Michael Blaire to explore with TRICARE how APC can assist the agency in preventing fraud, waste, and abuse while also expanding TRICARE coverage of compounded therapies for servicemen and -women.

From APC’s invitation letter to Col. Gmehlin:

There is no avoiding the truth that some pharmacy compounders engaged in TRICARE billing irregularities over the past decade and that our profession has earned a black eye because of those unethical practices. The reason for our interest in an ongoing dialogue with you and your team is to demonstrate our commitment to ethics and professionalism in pharmacy compounding by working with you to develop best practices and implement training to prevent those abuses going forward. We understand that until our industry can demonstrate high integrity in billing practices, TRICARE is unlikely to embrace compounded therapies for servicemembers, despite the positive patient outcomes they can produce and how cost effective they are.

On this week’s call, workgroup members presented the following rough plan of work to TRICARE leaders and asked that this plan be the focus of an ongoing dialogue with the agency:

  1. Develop best practices and training tools for reducing FW&A by compounding pharmacies.
  2. Demonstrate compounders’ commitment to quality, safety, effectiveness, and cost containment.
  3. Demonstrate efficacy of compounded therapy options for major health conditions involving active duty and veteran servicemembers – Traumatic Brain Injury, PTSD and Anxiety Disorder, Non-Opioid Pain Management, and more.
  4. Propose clinical protocols for therapy, labs, patient follow-up, and patient outcome reporting. (Ongoing over the next 12 months)

TRICARE leaders were receptive to the plan and committed to a monthly conversation with APC’s workgroup.