|
| |
|
|
From the Desk of the CMO (Article 2)
John E. Crum, M.D., Chief Medical Officer, Humana Military Healthcare Services, Inc. |
| |
In this newsletter message, I want to share with you the latest information about injectable specialty medications and TRICARE.
|
|
What Is Specialty Pharmacy?
|
|
New drugs like Xolair® for asthma, recombinant hemophilia factors, Avonex® for MS, and Enbrel® for rheumatoid arthritis are rapidly transforming medicine. These new high cost biotechnology drugs and injectable antineoplastic drugs are known as “specialty pharmacy” products.
These drugs are a breakthrough in the treatment of many chronic diseases. We expect to see 30 or more new products every year. This progress comes with a high price as most of these medicines cost more than a thousand dollars each month, some over $100,000 per year.
Specialty pharmacy is the fastest growing segment of drug costs in the U.S., rising 27 percent in 2003 according to Medco’s 2004 Drug Trend Report. Americans spent almost $30 billion on such specialty drugs in 2002, or 18 percent of U.S. spending on all prescription drugs. According to Express Scripts, the TRICARE Retail Pharmacy contractor, rheumatoid arthritis, multiple sclerosis, hepatitis C, asthma and growth hormone deficiency account for 76 percent of spending for specialty drugs other than antineoplastic drugs.
|
|
How Does TRICARE Cover These Drugs? |
|
TRICARE covers outpatient specialty pharmacy products in three ways:
|
|
- Administered and billed by the provider
- Administered by the provider and billed by a specialty pharmacy
- Administered by the patient and billed by a specialty pharmacy
|
|
Humana Military Healthcare Services processes claims for specialty drugs administered by providers, such as physicians and home health agencies. Allowable charges for these drugs are set by the government in the CMAC fee schedule.
Express Scripts processes claims for specialty products dispensed to beneficiaries for self-administration.
|
|
Can TRICARE Provide Injectable Drugs to My Office? |
|
Humana Military now has a network specialty pharmacy that can dispense prescriptions for TRICARE beneficiaries to provider offices. PrecisionRx Specialty Solutions can furnish essentially all specialty pharmacy products to providers and bills Humana Military directly. In this way providers can obtain these costly products without paying in advance and waiting for reimbursement. |
|
To order specialty drugs for administration by a provider ... |
|
The preferred method is to request a fax order form by calling PrecisionRx Specialty Solutions at 1-800-870-6419. You may also download a fax order form. |
|
To help beneficiaries obtain self-administered specialty drugs ... |
|
Beneficiaries may obtain self-administered specialty drugs through the TRICARE Retail Pharmacy Program (TRRx) by calling Express Scripts at 1-866-363-8779. |
|
To check the CMAC fee schedule ... |
|
Visit TRICARE's web site to access the CMAC fee schedule. |
| |
Back to Top
|
|
Last Reviewed: February 13, 2007
|
| |
|
| |
|
