TRICARE Uniform Formulary Update Announced

FALLS CHURCH, Va. – The placement of five additional, non-formulary (or third tier), medications on the TRICARE Uniform Formulary has been announced by Army Maj. Gen. Elder Granger, deputy director, TRICARE Management Activity.  Three of the medications change to non-formulary status on April 16, 2008, and two on June 18, 2008.   A sixth medication, Flomax, will remain non-formulary (third tier) under the Uniform Formulary, although additional step therapy/prior authorization requirements will begin on April 16, 2008.

No non-formulary (third tier) medications were identified in another reviewed class, the adrenergic beta-blocking agents. The following chart shows the medications and their status as formulary (first-tier generic or second-tier brand name medications) or non-formulary (third tier), along with the date the decision will be implemented.

First-tier medications (formulary generics) are available through a TRICARE Retail Pharmacy for $3 co-pays for up to a 30-day supply, and through the TRICARE Mail Order Pharmacy for $3 co-pays for up to a 90-day supply. Beneficiaries may purchase second-tier medications (formulary brand-name) for $9 for up to a 30-day supply through a TRICARE Retail Network Pharmacy, or up to a 90-day supply through the TRICARE Mail Order Pharmacy, with third tier (non-formulary) medications costing $22.  If beneficiaries use a TRICARE Retail Non-Network Pharmacy, the cost share for second tier medications (formulary brand name) up to a 30-day supply is the higher of $9 or, 20% and for third tier medications (non-formulary) the higher of $22, or 20%. 
Beneficiaries taking third-tier medications may consult their health care providers about changing to a first- or second-tier alternative.  When providers prescribe medications, beneficiaries should ask if a generic alternative is in that drug class available that would provide the same clinical results.

Beneficiaries can also ask providers if establishing medical necessity for the third-tier medication is appropriate.  If medical necessity is established for a third-tier medication, the co-payment is reduced to $9.  Third-tier medications are not available at military treatment facility (MTF) pharmacies unless an MTF provider establishes medical necessity and writes the prescription.  Medical necessity forms and criteria are available at www.tricare.mil/pharmacy/medical-nonformulary.cfm.

For a complete list of medications, their formulary status and where they are available, beneficiaries may visit www.tricareformularysearch.org/dod/medicationcenter/default.aspx.

Beneficiaries may find more information on the TRICARE Retail Pharmacy and locations, and the TRICARE Mail Order Pharmacy at www.express-scripts.com/TRICARE. They may also call 866-363-8779 for the retail pharmacy or 866-363-8667 for the mail order pharmacy. 

For more information about the Uniform Formulary Beneficiary Advisory Panel review process, visit www.tricare.mil/pharmacy/BAP.