July 24, 2020

The Tricare clawback issue isn’t over. Not by a long shot.

Last week, APC and NCPA were invited to participate in a phone call with representatives of ESI and the Defense Health Agency (including DHA’s acting chief, Colonel Markus Gmehlin). On that call, we explained in detail the many problems with the Tricare clawback that’s affected so many compounders.

What we were told

From Tricare and ESI’s perspective, the current suspension of recoupments is expected to be temporary — an interruption while DHA and ESI reassess the data they used to initiate the clawbacks.

In fact, DHA plans to continue the recoupment once it’s cleaned up and reanalyzed that data. Further, it has no plans to return any of the money already recouped until it completes that reassessment, and only if it feels there was an error.

Neither DHA nor ESI addressed the more fundamental issues, such as why pharmacists are being held accountable for alleged ‘errors’ by physicians, or how they can possibly meet ESI’s outrageous (and, frankly, impossible) demands for information.

In response to that meeting, APC, along with National Community Pharmacists Association and PAAS National, have sent a detailed letter to Col. Gmehlin, raising specific legal issues with the clawback as a whole, and requesting answers to our questions about how compounders are possibly expected to respond to ESI’s unreasonable demands.

That letter is available on on our Tricare clawback resources page at https://A4PC.org/tricareclawbacks.

What you need to do

Continue to reach out to your members of Congress to tell them what’s happening. Even DHA’s Col. Gmehlin was surprised at the extent of the issue, so it’s a fair bet that many of your representatives and senators aren’t aware of it.

APC has prepared a short briefing paper designed to be shared with your members of Congress. It explains the issue clearly and succinctly, and it’s something you should send to whoever you contact.

Also be sure to take a look at the communications kit you can find on our resources page (https://A4PC.org/tricareclawbacks) for tips on reaching out.

APC continues to work hard for you on this issue, so stay tuned for further developments.