Tricare Reject Code for Non Covered Compounded Drugs

Compounds Management
Starting May 1, 2015, Express Scripts will implement a new compounds management program for Tricare beneficiaries.
A number of agents will not be covered, causing compound claims to reject with NCPDP Reject 70 (Product/Service Not Covered), along with the Reject Field Occurrence Indicator (in NCPDP Field 546-4F) denoting the non-covered ingredient.
If this reject occurs, pharmacists may use one of the following options:

•   With approval of the prescribing physician, the non-covered ingredient may be switched to another covered ingredient or the member may be switched to an FDA-approved drug.
  
•   Re-submit the claim as-is using Submission Clarification Code 8 in NCPDP Field 420-DK to accept non-payment for non-covered ingredients. Please note SCC 8 may not be allowed for all scenarios and/or benefit designs.
  It is not recommended that pharmacists remove the non-covered ingredient in order to receive a paid response for the claim. In addition, providers may not attempt to circumvent the plan sponsor’s benefit design and coverage of compounded prescriptions or compound ingredients; including, but not limited to, re-submitting rejected compound prescription ingredients as individual, non-compound prescription claims.
  
  https://www.express-scripts.com/art/prc/Apr092015_Network_Pharmacy_Weekly.pdf