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Tricare Insurance to Drop Compounded Prescription Coverage

Lee SIlsbyAn important announcement from our friends at Lee Silsby Compounding Pharmacy, in Cleveland. When my children saw their first then "DAN!" doctor in 2000, we needed a scrip for Nystatin (shocking, I know...)  The CVS brand contained yellow dye and something like 35% sugar. I was fortunate to live in Cleveland, and the doc suggested I take my scrip to Lee Silsby. They custom compounded Nystatin with natural color and stevia. 

What if a patient has a food allergy and can not tolerate the milk or soy or dyes that are so often in mainstream pharmacy medications? That patient needs custom compounded products.  Sadly, Tricare, which is the healthcare program for  American military families, has just announced that it will no longer cover the cost of compounded medications after July 24.
If you are affected by this decision or know anyone in the military, please call Tricare and ask them to revert their decision. Their phone number is 1-877-363-1303 [CORRECTED].
You may also try to contact your representatives and let them know about how this decision will affect your family.
If Tricare succeeds in excluding compounded medications from their plan, other insurance plans may follow suit as the plans looks for ways to cut costs prior to the implementation of the Affordable Care Act.
Please help us fight this decision. Our families deserve better.

Lee Silsby Compounding Pharmacy


Lawrence Cox

Some people swear that these compounds work.Maybe they do but not at these crazy prices.This reminds me of the $500.00 hammers and the nuty cost of toilet seats the Government paid years ago this is just another scam to rip off the government and the tax payer.Open your eyes people.

Lawrence Cox

My doctor prescribed a Compound drug for my pain in my back.I paid 17.00 for my co-pay.When I received my EOB I almost passed out.They charged Tri Care over $15,000 and they paid over $12,000.The pharmacy did this three times at the same price and the government paid each time the same.I only received this Compound twice.Does anyone want some I have 5 and one half jars of worthless gunk.The Government got screwed again.I do believe that there is a scam between the doctors and the pharmacies,kickbacks.I do believe there needs to be an investigation and prosecution.

Donna "soreback"

Many compound Rx Pharmacies are charging Tricare pretty High Rates for compound creams. And Tricare seems to be paying close to the rates they are billed.

Are the compound companies charging Tricare such high rates in anticipation of Tricare instituting "Caps" in 2014? Are they trying to "grab high profits while the going is "Good"?


a disgusted person holding a Tricare EOB. I will not diclose the amount Tricare paid for this compound pain cream directed by the phx to check off a formulation. But it better be a "$10,000. oo mistake.

Don Bouton

I think all pharmacists, compounders as well as non-compounders need to threaten to strike or have a work stoppage if the problem of inconsistent & unfair coverage is not resolved. It really makes very little sense ehen in many cases compounded regimens using genrric ingredients are less costly than the manufactured trade name ones. If the coverage of compounding scripts is reduced it becomes a slippery slope on the coverage of manufactured meds down the line. Give them inch and they will take a mile!


tricare is fighting in my case over lidocaine - you know that crazy habit forming drug ! and the point is beyond what tricare will and wont pay for this effects everyone
An amendment may soon be offered on the Senate Floor ...
...that would limit available treatment options from compounded medications for dogs, cats and horses. The amendment is expected to be offered to S.959, legislation that is supposed to address the tragic situation in which a rouge pharmacy acted like a manufacturer and violated numerous laws, resulting in the death of many people and making even more gravely ill. But the Animal Health Institute (AHI), an organization created and funding by the big drug companies, is apparently trying to use this tragedy to eliminate competition and treatment options at the expense of our beloved pets.

The amendment that will soon be offered targets the availability of customized medications that a veterinarian believes is in the best interest of family pets and horses. These important treatment options entail making specialized drugs from active pharmaceutical ingredients in a precise dosage amount, or in a form that a veterinarian believes would increase compliance and the ease of administration. For example, a bitter tablet might be altered to a flavored powder that can be sprinkled on food, or a pill a pet refuses to swallow might be converted to a cream that can be rubbed onto the animal’s skin). Your pet gets the treatment it needs and deserves, but the drug companies do not get the profits they seem to think they are entitled to get.

The amendment was temporarily pulled from S.959 when it was approved on May 22, 2013 by the Senate Committee on Health, Education, Labor and Pensions. But as a lobbyist for AHI was recently quoted in a trade journal, ““We hope our absence from the bill is temporary.”

As published in an earlier draft of S.959 the proposal would do the following:

Veterinarians would be limited to the compounded medications they can prescribe to a list of bulk ingredients that are on a positive list created by the FDA. Elephants, giraffes, hamsters and other “minor species” would not be limited. This would be the first time that a medical provider (veterinarians) and a group of patients (dogs, cats and horses) would be limited to treatment options to a positive list developed by the federal government. It also would stifle innovation, as any new treatments could not be considered, as they would obviously not be included on the positive list.
The amendment would eliminate or drastically restrict the availability of compounded medications that are regularly stocked in veterinary offices for emergency or routine usage. This could delay or prevent treatment necessary to keep pets alive and healthy.
The FDA is given expanded new authority to classify variations of drug company products, which is the very definition of compounded medications, as illegal copies, further threatening treatment options. Veterinarians would still be able to prescribe some of these therapies under a limited exception contained in the bill, but FDA could impose new regulations and limitations that could make this difficult.
There is no legitimate medical reason to limit the treatment options for dogs, cats and horses while these same options would be available for zoo animals and other exotic pets. Yes, we want elephants and panda bears to live a long time. But we also want our family pets and horses to enjoy the same treatments to help them survive and stay healthy. An older dog, cat or horse can suffer from conditions such as diabetes, cancer and rheumatism. We need our veterinarians to have all the options they need at their disposal to give them the best care possible.

While this proposal is highly restrictive, it may not be enough to satisfy the Animal Health Institute. The same lobbyist quoted above talked about his disappointment with the “permissiveness” of the proposals listed above. Apparently it didn’t eliminate treatment options for dogs, cats and horses quickly enough. Send them a message by letting your Senator and Congressman that it’s the proposal of the Animal Health Institute that should be eliminated. Act now.


VETS ( animal vets ) Office use of compounded medications is critical to effective patient care in many settings. While emergency-use preparations are most widely recognized, prescribers in many specialties rely on office use to treat their patients, even when office administration is not necessary but treatment must begin immediately.

But Senate Bill 959, which is scheduled to come to a full-Senate vote during the week of July 15, would dramatically reduce your ability to order compounded preparations for office use. Although the bill is named for compounding for human health, there are two reasons it should matter to you as a veterinarian:
Animal health provisions are being prepared to insert as an amendment to the bill when it comes to the Senate floor for a vote next week.

If Federal legislation passes to prohibit ordering for office use in human health, it is likely that the individual states will treat animal health in the same way they treat human-health prescriptions.
Please take action today. Enter your email address and ZIP code to the right and click “continue.” Enter the additional information requested. Then, to the left on the same screen, customize the sample message. When you’re finished, click “send message” and it will be sent automatically to your Congressional representatives in the Senate and House. It will take just a few minutes of your time today to prevent an unconscionable and unworkable interruption of your practice and your patients’ health if S. 959 survives.


Legislation Passed by the U.S. Senate HELP Committee Could Put Your BHRT At Risk–Again.
On May 22, 2013 the U.S. Senate Committee on Health, Education, Labor and Pensions (HELP) passed a bill, S.959 that contains provisions that threaten access to compounded Bioidentical Hormone Replacement Therapy (BHRT) by both patients and providers. The entire Senate could consider the bill as early as late June 2013.

This bill would give the Food and Drug Administration (FDA) broad and unprecedented powers to regulate compounding pharmacy, including the power to reduce or eliminate access to certain compounded medications used for BHRT. Here is a description of the main provisions of this legislation:

S.959 grants FDA the authority ban certain components of compounded BHRT if, in the opinion of the FDA, they pose “public health concerns.” In 2008, FDA took similar action against the female hormone estriol, a component contained in approximately 80 percent of all compounded estrogens. FDA’s action was in direct response to a request in a “Citizen Petition” filed by a drug company with synthetic hormones that competed with BHRT. FDA instituted import bans on estriol and sent warning letters to suppliers and pharmacies trying to prevent or limit women from obtaining BHRT with estriol. FDA was unable to enforce these actions. S.959 gives them that authority.

S.959 greatly expands the definition of a “copy” of a drug company product to include a “variation.” FDA is given expansive authority to determine the definition of variation, and would have the power to determine that compounded BHRT medications are copies of one-size-fits-all and synthetic hormones manufactured by drug companies. This could turn compounded BHRT into an illegal copy of a drug company product.

While there is an exception that allows a provider to continue to write prescriptions for the now illegal BHRT, under S.959 he or she would have to determine that BHRT produces a “clinic difference” in a patient’s treatment outcome as opposed to using the drug company product. While a doctor would be able to make this determination, the bill would allow the FDA to determine compliance.

In the past, FDA attempted to require practitioners to file costly and invasive Investigative New Drug applications (INDs) for certain compounded BHRT. The agency refused to recognize the considerable expense and bureaucratic procedures involved in setting up and IND. Instead, FDA dismissed legitimate concerns as “misconceptions that obtaining an IND is costly, cumbersome, and time consuming process.” A requirement for an IND for such commonly used medication is an unwarranted intrusion of federal bureaucrats into the patient/provider relationship. But it would be allowed under S.959.

For men, compounded testosterone therapy (both injectable versions and creams) could be determined to be copies of manufactured products. Even if a provider can justify a clinic difference in outcomes, S.959 would allow FDA to erect barriers to the prescribing of these medications.

FDA has demonstrated hostility towards BHRT in the past, and on its website it still has a consumer alert stating, “’BHRT’ is a marketing term not recognized by FDA.” In the same alert, which was specifically requested by the drug company filing the Citizen Petition mentioned about, FDA denies the scientific fact that bioidentical hormones are identical to hormones made by the body. With such contempt toward BHRT, giving FDA broad and sweeping powers over patient and provider access to these medications, as is contained in S.959, is frightening.


I have a complex pelvic pain condition - with severe and disabling pain
I relie on my compounding meds to acheive any sort of daily comfort
> these aren't off label or unknown - but established standard treatments for my condition

and just receive a letter from express scripts saying they would not be covering any of the meds I use to even slightly feel normal - so yes tricare has no intentions of covering any compounded meds

What you dont seem to realize is this effects everyone !

pet owners- vets
parents with kids with autism. allergics , ADHD ect
anyone on hormonal bio identical hormones ( so forget having sex after 45)
pain patients
cancer patients
and the blessed MDS that treat these devasting conditions

Im already out of luck - our out of pocket some $8000 /yr on
know pain treatments that Drs at Walter Reed Pioneered !!

yet as a dependent - tricare refuses to either pay for them
no let me go to Walter reed / bethesda

the MDs at walter Reed and Hopkins want to treat me- tricare just won't allow it

So thinking Tricare and the DoD , gives a damn about its vetrans or active duty members and their families - You are delusional - and they will continue to reduce what they will pay for the longer we ( collectively ) let them

I could be a contrubiting member of society , perhaps even back to my very successful
28 yr career - oh - self employed , and a recent citizen ( 2006) moved here in 1995 to attend university , so forget disablitity benefits .
But , ever since I fell on my sacrum in Dec 2008 - cause major nerve damage ( S2-S4)
look up Pudendal Neuralgia

But , have fought tricare this entire hellish journey
18 months for dx
had to appeal for surgery by the only NS in the US that Hopkins said was qualified
fought for and lost every treatment for centralized pain - Tricare's fault over delayed dx and run arounds .

the crazy thing is they allow crazy expensive non effective drugs - often the same ones that get pulled off the market years later
But , something cheap, safe, effective and hey - the MDs at Walter Reed pioneered
forget it .

are we angry - beyond
My husband was in boot camp during 9/11 , he joined the military to give us a better life.

and thats been far from the case for us.


Compounding pharmacies are to Pharma what alternative medicine is to Medicine. This is all part of the same effort to squash competition that would provide individualized, truly science based care and that is outside of large corporate control.


I don't believe that TRICARE is going to stop covering compounded medications entirely, just those that contain ingredients that aren't FDA-approved, which is normal since TRICARE doesn't cover drugs that aren't FDA-approved.

I found this information on the TRICARE website www.tricare.mil/Pharmacy/Medications/MedsNotCovered.aspx?sc_database=web

The number is 1-877-363-1303 for Express Scripts it's also on the page as well.


Tricare members should call Express Scripts at the number above as well as senator Levin, chairman of the armed forces senate committee (202) 224-3871. Express scripts does not do anything without the directive from the military. There are ways to control the costs of this benefit by limiting the amount they are willing to pay for a compounded Rx (many commercial plans do this already) vs eliminating the coverage entirely. Our military families do deserve better! Tricare will also set precedence for other insurers. I would encourage everyone who sees the value in compounding medications to speak out and contact Levin's office.


I should add that our insurance company is not paying a dime for our seizure medicine anyway.
The last couple of years they claimed it was a pre-exisitng illness so they did not have to pay.
This year we are still paying the same amount.

Good news:
The medical community cannot charge me just anything that is on their little minds. I have the health insurance company going in and setting the price way before hand. Yes, they have gone in and negoitated prices for me. They won't pay a dime to the psych, but the psych can only charge me 130 dollars. Although I have gone to other psychs in the past that only charge 65, but that is beside the point - this psych was allowed to charge me 130.

So, if they have to fly me in a helicopter to a bigger city with more options on emergency operations -- they can only charge me 10,000 dollars-- and not 50,000 if I was just little ol'e me -- and did not have a big bad insurance company backing me on the price..


Nystatin if an antifungal drug - and fungus loves sugar. So a diet that has a low carb count and the esp means "Sugar"

Good gosh!

That is a problem with some of the seizure meds too. Generic means - I thought the exact same stuff and measurements -- but I found out that it is not the same - that the amounts of the seizure drug can be off by a lot.

Is this what the public is going to have to fight forever more?

Kentucky finally did make a law that just because there is a generic drug - does not mean a patient with eplipsy has to use it.

But it does not matter now does it -- the insurance companies will get out of it - in other ways too.

I am beginning to think that the force that help write Obama Care was the health insurance companies. Since it has gone into affect - my bill each month I pay out for myself and my son had gone up 30 dollars extra a month.

When my son smashed his finger between a cattle loader and cattle hauler this spring and had to have stitches -- the insurance company paid a whopping 100 dollars -- I paid the other 700.

WHy in the heck would a smashed finger, and few stitches call for 800 dollars to fix anyway?


Aetna stopped for us last year

IAngus Files

Shocking same here in the UK big banner welcome home lads..after that the heroes are hung out to dry...shocking!!


Thanks to Lee Silsby and AofA for getting the word out. I will make sure to get our Rxs re-filled before then. Tricare does NOT notify military members of changes in coverage or co-pays. You just find out at the next visit/refill.


We just got a letter from our healthcare provider (United Healthcare) saying the they will no longer cover any portion of the cost of B12 shots from compounding pharmacies b/c its not FDA approved.

katie kelley

there is a digit missing in the number. I believe the correct number is 1-877-363-3013.


the number is 1-877-363-1303


This issue is outrageous. Yet again it's an attack on choice, but also on necessity. Want your meds without allergens and dyes? Not a chance. Tricare has gone from being a worthwhile benefit to an absolute joke. Our military families deserve better.

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