Humana has recently been sending letters to pharmacies seeking recoupment of overpayment for pain patches and/or compound kits which have already been adjudicated and dispensed to patients based on the patches and kits not being FDA approved.
In the letter, Humana states that prescription medication must be FDA approved to be covered, in accordance with the Humana members’ coverage certificate. Humana is claiming the right to recoupment based on their Provider Agreement and giving 30 days for the pharmacy to pay or otherwise response to the demand.
Pharmacies have the right to appeal these recoupments. Frier Levitt has closely monitored the variety of kits and patches that have appeared on the market and understands the unique issues related to dispensing these products. Contact us today if your pharmacy needs assistance with the appeals process.
