The Department of Defense (DoD) mandatory generic drug program requires that prescriptions be filled with the generic product, if one is available, at the generic copayment. If a generic equivalent does not exist, the brand-name drug is dispensed at the higher formulary copayment.

The DoD estimates that the Military Health System’s use of generics saves almost $50 million per year. Generic medications work as well as their brand-name counterparts in dosage, strength, performance and use. They must meet the same Food and Drug Administration (FDA) quality and safety standards.

If you feel that a brand-name drug (for which a generic equivalent is available) is medically necessary for a beneficiary, it is recommended that you receive authorization from Express Scripts, the TRICARE Retail Pharmacy (TRRx) program administrator, prior to writing the prescription. Otherwise, the beneficiary may be responsible for the entire cost of the medication.

Medical necessity waivers are approved if one or more of the following situations exist:
 

• The patient must experience, or would be likely to experience, significant adverse effects from the generic medication.
• The generic medication has resulted in, or is likely to result in, therapeutic failure.
• The patient has previously responded to the brand-name medication, and changing to the generic medication would incur an unacceptable clinical risk.

To obtain a medical necessity waiver, call the TRRx Prior Authorization Line at 1-866-684-4488. You will be asked to complete and submit a Prior Authorization Request Form.

Once Express Scripts has approved the request, you will receive a “letter of medical necessity,” which the beneficiary must present with the prescription at the pharmacy.

To learn more about the DoD’s generic drug program, medical necessity waivers or TRRx, visit the  Express Scripts Web site or call 1-866-DoD-TRRx.

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Contacts (Article 19)

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Last Reviewed:  February 2, 2007