Five more drugs going to $22 under Tricare

[cec]

Five more drugs going to $22 under Tricare




By Karen Jowers - Staff writer
Posted : Monday Mar 10, 2008 17:38:47 EDT

The Defense Department is moving five more medications to its highest price tier, which means they will cost Tricare beneficiaries $22 per prescription, officials announced Monday.
The medications that will move to Tricare’s “third tier,” or nonformulary list, are the rheumatoid arthritis drugs Enbrel and Kineret; hypertension drug Exforge; attention deficit hyperactivity drug Vyvanse; and contraceptive Lybrel.
Exforge, Vyvanse and Lybrel will move to the third tier on April 16. The rheumatoid arthritis drugs will follow on June 18.
A sixth medication, the prostate drug Flomax remains a “third tier” drug, but as of April 16, step therapy and prior authorization requirements will apply to first-time patients who are newly starting on that drug. Step therapy involves beginning drug therapy for a medical condition with the most cost-effective and safest drug therapy — often a generic drug — and moving to other more costly or risky therapy only if necessary.
The announcement is the latest in a series of changes to the Tricare formulary in recent years aimed at encouraging beneficiaries to use less costly generic drugs when possible.
Prescriptions for medications in the formulary — the official list of drugs offered through the Tricare Pharmacy Program — listed on the third tier carry a beneficiary co-payment of $22, regardless of whether the drug is purchased at a Tricare network retail pharmacy or through the Mail-Order Pharmacy Program.
In contrast, the co-pay for first-tier medications — generic drugs — is $3 for a 90-day supply if purchased through the mail and the same for a 30-day supply purchased at a Tricare network retail pharmacy.
For second-tier drugs — brand-name medications with no generic equivalent — the co-pay is $9 for a 90-day supply through the mail and the same for a 30-day supply from a Tricare network retail pharmacy.
Beneficiaries can get a price break on third-tier drugs if their doctor certifies that a specific medication on that tier is medically necessary. If so, the co-payment drops to $9.
Third-tier medications are not available at military treatment facility pharmacies unless an MTF provider certifies a medical necessity for the drug and writes the prescription.
Tricare keeps a complete online list of drugs, their formulary status and where they are available at http://www.tricareformularysearch.or...r/default.aspx.
More information on the Tricare retail and mail-order pharmacy programs is available online at Welcome TRICARE Beneficiaries - Express-Scripts.com or by calling toll-free 866-363-8779 for the retail pharmacy or 866-363-8667 for the mail order pharmacy.
More information about the Uniform Formulary Beneficiary Advisory Panel review process, which advises Defense Department health officials on potential changes to the formulary, is online at Department of Defense Beneficiary Advisory Panel (BAP).



Five more drugs going to $22 under Tricare - Army News, opinions, editorials, news from Iraq, photos, reports - Army Times



-