Learn About TRICARE Pharmacy Network Changes for Specialty Drugs
March 12, 2024
FALLS CHURCH, Va. – The TRICARE Pharmacy Program is improving how we manage specialty drugs.
Starting March 1, Accredo will provide specialty drugs and enhanced clinical services if you fill TRICARE-defined specialty prescriptions with TRICARE Home Delivery. Accredo will also stay in the TRICARE network as an in-network retail pharmacy.
If you or a family member takes specialty drugs, these changes may help you access and afford these drugs.
“Specialty drugs are essential for a lot of our beneficiaries,” said U.S. Public Health Service Cmdr. Teisha A. Robertson, Deputy Chief of the Purchased Care Branch at the Defense Health Agency. “These updates to TRICARE’s pharmacy network will give military families with complex and chronic health conditions more support in managing their drugs.”
Accredo is an accredited specialty pharmacy that serves patients with complex and chronic health conditions.
With Accredo, you’ll have 24/7 access to a clinical care team. This team may include specialty-trained pharmacists, nurses, patient care advocates, and other professionals. This team will help you better manage your treatment with specialty drugs.
Read on to learn more about these changes.
Q: How are specialty drugs defined or identified?
A: Specialty drugs are used to treat chronic, complex conditions. Specialty drugs include drugs that can be injected, infused, or inhaled. Some specialty drugs may require special handling, such as refrigeration. TRICARE defines specialty drugs through the Department of Defense Pharmacy and Therapeutics process. Go to Specialty Drugs to see the TRICARE specialty drug list.
Q: I currently take specialty drugs. How will these changes affect me?
A: It depends on how you currently fill your prescription and the drug you need.
Do you have an active prescription with refills for a specialty drug at TRICARE Home Delivery administered by Express Scripts Pharmacy? If so, your prescription will be automatically transferred to Accredo.
Do you currently get specialty prescriptions at a retail pharmacy? In some cases, you may be required to fill these prescriptions through TRICARE Home Delivery or a military pharmacy, if available. If your specialty drug is on the maintenance drug list as of March 1:
- Express Scripts will contact you with instructions for transferring your prescription to TRICARE Home Delivery or a military pharmacy.
- After two fills at a retail pharmacy, you’ll have to pay full price for your prescription.
This doesn’t apply to active duty service members. It also doesn’t apply if you have other prescription drug coverage or live overseas.
Q: Do I need to do anything to switch my specialty drug prescription to Accredo?
A: If you already get your specialty drug at Express Scripts Pharmacy you don’t need to do anything. Your prescription will be automatically transferred to Accredo. Accredo’s clinical care team will contact you to complete the onboarding process.
If your specialty drug is on the maintenance drug list, Express Scripts will contact you with instructions for transferring your prescription. You can also call Accredo at 1-877-882-3324 to transfer your prescription.
Q: What are my options for filling a specialty drug prescription?
A: The TRICARE network for specialty drugs will include:
- In-network retail pharmacies, including Accredo
- TRICARE Home Delivery, including specialty pharmacy services provided by Accredo
- Military pharmacies
Starting March 1, the TRICARE Formulary Search Tool will show you where your specialty drugs may be available.
You may also use a non-network pharmacy. Using a non-network pharmacy is your most expensive option. You must pay full price and file a claim for reimbursement. Non-network deductibles and cost-shares apply.
Q: Will my out-of-pocket costs change?
A: It depends. Your costs won’t change if you already fill your specialty prescription through TRICARE Home Delivery. For prescriptions that you already fill at a retail pharmacy including Accredo, your costs may change from the retail network pharmacy copayment to the TRICARE Home Delivery copayment starting March 1.
The TRICARE Pharmacy Program Overview Fact Sheet outlines how your costs are based on who you are, the prescription drug category, and where you fill your prescription. You can view your current pharmacy copayments on the TRICARE website. Starting March 1, the TRICARE Formulary Search Tool will show you the updated copayment for your prescription.
Q: How do I switch to Accredo?
A: You can call Accredo at 1-877-882-3324. A patient care advocate will work with you and your doctor to get a new prescription sent to Accredo. Since Accredo is part of the pharmacy network right now, you can move your prescription before March 1.
If you need help finding a pharmacy to fill your specialty drugs, visit Express Scripts. To learn more about TRICARE’s coverage of specialty drugs, go to Covered Services.
Article Source: Learn About TRICARE Pharmacy Network Changes for Specialty Drugs