Notice of Non-coverage for Certain Compounded Drugs
Posted February 13, 2023
A review by the Pharmacy Advisory Board of the Defense Health Agency (DHA) found compounded drugs, which traditionally accounted for a small proportion of pharmaceutical expenditures, grew to over $500 million by 2015. The dramatic increase was largely due to multiple fraudulent schemes related to drug compounding and billing.
To combat fraud and ensure patient safety, DHA adopted the Express Scripts Incorporated (ESI) Commercial Reject List. The ESI’s Commercial Reject List verifies that each ingredient is safe, effective, and covered by TRICARE. With the current implementation of the DHA’s new electronic health record, MHS GENESIS, only compounds recognized by ESI, covered for the indication prescribed, and approved for standardized use, will be compounded by National Capital Region (NCR) Market pharmacies...."https://walterreed.tricare.mil/News-Gallery/Alerts/Compounded-Medications
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