TRICARE Revises Compound Drug Coverage

Starting May 1, 2015, Express Scripts, the TRICARE pharmacy contractor, will screen all ingredients in compound drug claims to ensure they are safe and effective, and covered by TRICARE. This screening process is like the one TRICARE already uses for other prescription drugs, but it will now apply to the ingredients in compound drugs.

Compound drugs are a combination of drug ingredients prepared by a pharmacist for a patient’s individual needs. TRICARE beneficiaries taking a compound drug likely to be impacted by the change will soon receive a letter explaining the new process for screening compound drugs, and what steps they should follow.

Use of compound drugs has increased greatly in recent years. However, some compound drug ingredients have limited or no evidence that they are safe and effective. If a compound does not pass an initial screen, the pharmacist can switch a non-approved ingredient with an approved one, or request the doctor write a new prescription. If this is not possible, the doctor may ask Express Scripts to consider other evidence by requesting a prior authorization.

The Defense Health Agency’s highest priority is to provide our beneficiaries safe and effective care while being responsible stewards of taxpayer dollars. Many compound drugs will still be covered because they include ingredients proven to be safe, and most beneficiaries will experience no delay in getting their prescriptions. For more information about TRICARE coverage of compound drugs, visit the TRICARE Compound Drugs page. If you receive a letter from Express Scripts, you can call customer serivce at 1-877-363-1303 for more information on your prescription.

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