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TRICARE has selected three medications to be designated as non-formulary: Nexium® (esomeprazole), a medication for ulcers and other stomach problems, and Teveten® (eprosartan) and Teveten® HCT (eprosartan with hydrochlorothiazide), both used to treat high blood pressure.
“With the selection of the first three non-formulary drugs, we have taken an important step in standardizing formulary management within the Department of Defense,” said Dr. William Winkenwerder Jr., Assistant Secretary of Defense for Health Affairs and director of TRICARE.”
Patients currently using Nexium, Teveten or Teveten HCT may consult you about prescribing formulary alternatives. A summary of formulary alternatives to the non-formulary medications and their corresponding copayment is listed in the chart listed below.
| Non-Formulary |
Formulary Alternative |
Copayment |
| Nexium® |
Omeprazole |
$3 |
| AcipHex® |
$9 |
| Protonix® |
$9 |
| Prevacid® |
$9 |
| Zegerid® |
$9 |
| Teveten /Teveten HCT® |
Avapro®/Avalide® |
$9 |
| Cozaar®/Hyzaar® |
$9 |
| Diovan®/Diovan HCT® |
$9 |
| Micardis®/Micardis HCT® |
$9 |
| Atacand®/Atacand HCT® |
$9 |
| Benicar®/Benicar HCT® |
$9 |
Nexium, Teveten or Teveten HCT will not be routinely available on local military treatment facility (MTF) formularies. MTFs will be able to fill non-formulary requests for these medications only if both of the following conditions are met:
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An MTF provider writes the prescription, and
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Medical necessity is established for these products
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MTFs may (but are not required to) fill a Nexium, Teveten or Teveten HCT prescription written by a non-MTF provider to whom the patient was referred by the MTF, as long as medical necessity has been established.
If a patient still balks at disclosure, documentation of the patient’s refusal must be faxed to Humana Military.
Establishing Medical Necessity
Proof of medical necessity is not needed in order for your patient to fill a non-formulary medication through the TRICARE Retail Pharmacy program or the TRICARE Mail Order Pharmacy program, unless your patient is an active duty service member. If you feel that it is medically necessary for your patients to receive a non-formulary medication instead of any of the formulary alternatives that are on the Uniform Formulary, the medication can be provided at the formulary copayment if you can substantiate medical necessity.
Medical Necessity Forms are available on the TRICARE Pharmacy Web site. Procedures for how to complete and submit medical necessity information can be found on the form.
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