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Pharmaceutical Manufacturers: Disputes Resolution

Disputes Resolution

Q1:

In my data there looks to be duplicates of the same Rx number filled on the same date of service. Is that possible?

A:

Yes. Examples include; duplicate inhalers for school and home, vacation supplies, lost medication, or provider prescribed increased dosages. It is important to take this into consideration when disputing utilization data.

Q2:

My K codes have been rejected, but I know that these are 340b pharmacies.

A:

DHA requires that a Manufacturer TRICARE Retail Refund 340b Verification Form be completed by the pharmacy to validate that a prescription was dispensed with 340b product prior to accepting these disputes. Please refer to the Manufacturer Policy and Procedure guide for more information regarding K Codes.

The 340b Verification Form can be found under our Operational Documents.

Q3:

What pharmacies are eligible for the TRICARE Retail Refund Program?

A:

TRICARE retail pharmacy includes long term care facilities, specialty pharmacies, pharmacies inside a physician's office and hospital, and all other pharmacies identified as part of the TRICARE Retail Network. Please refer to the Manufacturer Policy and Procedure guide available in our Operational Documents for more information regarding pharmacy eligibility.

Last Updated: January 30, 2024
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