By Russ Van Arsdale, executive director Northeast CONTACT
Posted May 10, 2015, at 4:35 p.m.
The Defense Health Agency has been warning military families and veterans covered by TRICARE about scams involving “call centers.” Callers ask clients to reveal personal and medical information over the phone, with promises to help them get medications.
TRICARE is a civilian health care program run by the U.S. Department of Defense Military Health System. It offers benefits for active duty service people, retirees and their families. The program was formerly known as the Civilian Health and Medical Program of the Uniformed Services, or CHAMPUS.
A call from a “call center” generally begins with the caller claiming to be from a sound-alike agency, “calling to tell you about a prescription pain cream you qualify for that TRICARE will cover.” The caller chats up the client — sometimes using personal information gleaned from Google or other sources — and asks for the name of the client’s doctor and other TRICARE information.
“TRICARE will never call beneficiaries and ask for personal information,” Defense Health Agency spokesman Kevin Dwyer said.
But others will, including a host of less-than-reputable companies that deal in compounded prescriptions.
A recent article on the Military Times website notes a huge increase in compounded medications, from $5 million in 2004 to over $700 million in the first three months of this year.
The boom in sales has attracted aggressive marketers, who cold call TRICARE clients, ask if they have certain medical needs and if so, whether they are interested in compound medications. The meds can cost a few hundred dollars to more than $9,000 for a prescription.
The Military Times article cites an ad on Craigslist searching for both customers and sales representatives. The ad claimed meds are “handcrafted for every individual” and formulated to help deal with everything from post-traumatic stress disorder to chronic pain and scars.
Supporters of the compounding industry say the majority of its members are small companies that try to help patients and want a fair price in return. But the entry of hustlers during a time of changing regulation has put the industry under a microscope.
Starting May 1, Express Scripts, which administers the TRICARE pharmacy program, is under orders to screen every ingredient in compounded meds to make sure substances meet Food and Drug Administration regulations. TRICARE will cover those with allowable ingredients; others will have to be reformulated or will need prior approval to be covered.
It’s unclear how many recent prescriptions may not be reimbursable.
In any case, those cold calls are likely to keep coming.
TRICARE officials say beneficiaries should never reveal personal or financial information over the phone. If they receive such a call, they’re urged to call Express Scripts at 866-759-6139 or 866-216-7096 or email email@example.com.
Betty Balderston, statewide coordinator for Maine Senior Medicare Patrol, alerted Northeast CONTACT to the cold calling. She urges all seniors who receive similar calls to avoid revealing personal and financial information.
Consumer Forum is a collaboration of the Bangor Daily News and Northeast CONTACT, Maine’s all-volunteer, nonprofit consumer organization. For assistance with consumer-related issues, including consumer fraud and identity theft, or for information, write Consumer Forum, P.O. Box 486, Brewer, ME 04412, visithttps://necontact.wordpress.com or email firstname.lastname@example.org.