TRICARE and show your military ID card. You also can search for a net- work pharmacy online by entering your ZIP code at www.express-scrip
ts.com/TRICARE/pharmacy or by calling (877) 363-1303. Non-network pharmacy: This is the most expensive method and should be used only in emergency situations when no network phar- macy is available. If you elect to receive your medications from a non- network pharmacy, it’s going to cost you. You’ll end up paying the higher of the retail copayment or 20 percent of the cost of the drug. Given all of this information, what
is the best way for you to get the cor- rect and most cost-effective medica- tions to manage your health?
Finding other options To look for other drugs in a certain class and compare your options, go to
www.tricare.mil/pharmacy and click on the Search the TRICARE Formulary button. Once on the De- fense Health Agency (DHA) Phar- macy Operations Division site, enter your medication name in the TRI- CARE Formulary Search Tool box, which yields various dosing options in terms of amount and type (tablet, capsule, injection, liquid, etcetera). Click on the appropriate option to see the cost data and point of service for your medication as well as any medical-necessity or prior-authori- zation forms or step-therapy require- ments. Then scroll down the page to see a list of other drugs in that class and their corresponding information. Print out this information for each medication you currently take, and bring it with you to your next ap- pointment. It might help your health care provider better manage your symptoms and diagnosis within the TRICARE Uniform Formulary. Primary and specialty providers are
very busy. It’s unreasonable to expect them to commit to memory the medi-
Mail-Order Mandate Effective Oct. 1, 2015, all non-active duty TRICARE beneficiaries are re- quired to refill select maintenance drugs through TRICARE Pharmacy Home Delivery or at military treatment facility pharmacies. (See page 34.)
cations on the multitude of formular- ies of all the patients they see. Some use electronic prescribing systems or applications on their mobile devices to assist them. Others might participate in e-scribing. It pays to help your doc- tors know their options to deliver the safest, most effective, and most cost- effective medications for you.
Uniform Formulary The DoD Pharmacy and Therapeu- tics Committee is responsible for the development and maintenance of a uniform formulary. It is made up of military and federal members whose primary mission is to uniformly, consistently, and equitably provide appropriate drug therapy to meet patients’ clinical needs in an effective, efficient, and fiscally responsible man- ner. The committee focuses on actions encouraging the safe and effective use of pharmaceutical agents that will produce the desired outcomes of drug therapy at a reasonable cost to DoD. Each class of drugs listed in TRI-
CARE’s Uniform Formulary is sub- ject to quarterly reviews. Before any change is enacted to the Uniform Formulary, affected beneficiaries will receive a letter from the DHA via its support contractor Express Scripts Inc. This letter outlines the change and what action is available to the beneficiary. If you receive a Uniform Formulary change letter, schedule a visit with your provider to discuss your medication choice. Once the change goes into effect, you will need to comply with the require- ments outlined. In some instances, you might be grandfathered, meaning no change is needed. In others, you’ll need to try a new medication or meet
established criteria outlined in your Uniform Formulary change letter. Pay close attention and plan accordingly, so you don’t run short of your needed medications or end up paying the full cost of your prescriptions because you failed to adhere to DHA’s letter of instruction regarding a TRICARE Uniform Formulary change. Visit the DHA Pharmacy Opera- tions Division website, http://pec.ha
.osd.mil/formulary_search.php, to find information regarding the pharmacy program and the DoD Pharmacy and Therapeutics Committee that man- ages the process described. As with most commercial plans, TRICARE’s Uniform Formulary pharmacy benefit default is the generic medication. Generics are more widely available and are cost- effective for current and future ben- eficiaries. That being said, should your provider determine you need a brand-name medication, have your provider submit either a prior-autho- rization form justifying the need for a brand-name medication or a med- ical-necessity form that justifies the need in addition to why you are un- able to use the other approved drugs in a class or abide by the step-thera- py requirements. This form is avail- able as a link under “Are there forms my doctor may need to fill out?” once you enter the brand-name medica- tion name in the Formulary Search Tool. The applicable form provides the criteria that must be met to sub- stantiate the need, along with the fax number for Express Scripts Inc.
MO
— Cmdr. Katherine O’Neill Tracy, USN (Ret), is a deputy director and ben- efits expert in MOAA’s Transition Center.
OCTOBER 2015 MILITARY OFFICER 67
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