TRICARE Revises Compound Drug Coverage

By TRICARE
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Falls Church, Va., May 1, 2015 - On May 1, 2015, Express Scripts, the TRICARE pharmacy contractor, begins screening the ingredients in all compound drug claims to ensure they are safe and effective, and covered by TRICARE. This screening process is like the one TRICARE uses for other prescription drugs, and will help meet the Military Health System's goal of ensuring we are providing safe and effective care to service members and their families.

Compound drugs are a combination of drug or ingredients prepared by a pharmacist for a patient's individual medical needs. In March 2015, TRICARE beneficiaries taking a compound drug likely to be impacted by the change received letters from Express Scripts, the TRICARE pharmacy contractor, explaining the new process for screening compound drugs. Many compound drugs will pass the screen with no delay to beneficiaries. For more information on the screening process, visit TRICARE's Compound Drugs web page.

The Military Health System's highest priority is to provide our beneficiaries safe and effective care while being responsible stewards of taxpayer dollars. Some compound drugs contain ingredients with limited or no evidence that they are safe and effective. These are often topically applied pain or scar creams, which can include combinations of potent painkillers, muscle relaxants, anticonvulsants, anti-inflammatories and other ingredients. The Military Health System has found there is a lack of evidence to demonstrate how these ingredients interact with each other when applied topically.

In recent months, Military Health System costs for compound drugs have skyrocketed from about $54 million in August 2014 to more than $330 million in March 2015. Also, in March and April, TRICARE received growing number of reports from beneficiaries that they have been the target of unsolicited marketing efforts trying to collect personal information and send them unwanted prescriptions, which are then billed at great cost to the TRICARE. TRICARE recommends that beneficiaries contact in this manner do not provide any personal information, and report the activity to Express Scripts at 1-866-759-6139 or TRICAREfraudtip@express-scripts.com.

For more information about TRICARE coverage of compound drugs, visit visit TRICARE's Compound Drugs web page.