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One year ago this June, Express Scripts, Inc. began administering the new, nationwide TRICARE Retail Pharmacy (TRRx) program. Thanks to this program, TRICARE beneficiaries can travel anywhere across the U.S. or its territories and have their prescriptions filled easily at any of 53,000 network retail pharmacy locations.
The TRRx program has also meant that the Department of Defense’s (DoD) 10-year-old, mandatory generic drug program is now being enforced more consistently across the nation. This program requires that prescriptions be filled with the generic product, if one is available, at the generic co-payment. If a generic equivalent does not exist, the brand-name drug is dispensed at the brand name co-payment.
Saving Millions
“DoD’s long standing mandatory generic policy has saved our beneficiaries and taxpayers countless millions of dollars while providing quality pharmaceutical products,” explains Col. James Young, director of DoD Pharmacy Programs for the Office of the Assistant Secretary of Defense.
“We encourage you to prescribe generic products whenever possible. In doing so, you help us conserve valuable resources that enable us to continue our commitment to provide the best pharmaceutical care to all our beneficiaries,” continues Col. Young. “It is estimated that the use of generics saves DoD almost $50 million per year, and it is a tribute to you that this process is working so well.”
Generic medications work the same 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.
Prescribing Brand Name Instead
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 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:
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The patient must experience, or would be likely to experience, significant adverse effects from the generic medication.
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The generic medication has resulted in, or is likely to result in, therapeutic failure.
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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 (also available in the frequently asked questions (FAQs) portion of the Express Scripts Web site www.express-scripts.com/TRICARE).
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. At that time, the pharmacist will provide the beneficiary with the brand-name medication at the brand-name co-payment.
Getting More Information
For more information about the safety and reliability of generic medications, visit the FDA Web site at www.fda.gov.
To learn more about medical necessity waivers or the TRRx program, visit www.express-scripts.com/TRICARE or call
1-866-DoD-TRRx.
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