TRICARE Retail Pharmacy Program Consolidated Under Single Contractor   (Article 6)


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As of June 1, 2004, Express Scripts, Inc. of Maryland Heights, Mo., became the
sole benefit manager of the Department of Defense (DoD) TRICARE Retail
Pharmacy (TRRx) program.

Previously administered by the TRICARE managed care support contractors in each
region, the retail pharmacy benefit was not portable for beneficiaries traveling out of their regions. Under the new nationwide program, beneficiaries now have access to a network
of about 53,000 retail pharmacies throughout the U.S., the District of Columbia, Guam, Puerto Rico and the U.S. Virgin Islands.
For providers, there is not much change under the new TRRx program. The same rules concerning TRICARE covered
and non-covered medications apply. There are no changes to the current quantity limits, as listed on the DoD Quantity Limits for Prescription Drugs and Products page (www.pec.ha.osd.mil/qtylimit.htm ).

For providers, there is not much change under the new TRRx program.
  • The same rules concerning TRICARE covered and non-covered medications apply.
  • There are no changes to the current quantity limits, as listed on the DoD Quantity Limits for Prescription Drugs
    and Products page (    www.pec.ha.osd.mil/qtylimit.htm).

Prior Authorization Determinations
Through the DoD Pharmacy and Therapeutics (P&T) Committee, the list of medications requiring prior authorization
is being standardized across all TRRx points of service and the TRICARE Mail Order Pharmacy (TMOP) program. The
list of medications requiring prior authorization under TRICARE will likely continue to be very small.

The DoD P&T Committee will meet quarterly, and over time may make changes to the list of drugs requiring prior authorization. TRICARE formulary information, to include drugs requiring prior authorization, may be found at: www.tricare.osd.mil/pharmacy.

Please review the following list of drugs requiring prior authorization as of June 2004 that may affect your practice.
The generic equivalent for each drug is noted in parentheses.
  • Viagra (Sildenafil)
  • Levitra (Vardenafil)
  • Cialis (Tadalafil)
  • Enbrel (Etanercept)
  • Humira (Adalimumab)
  • Injectable gonadotropins [fertility agents], including: follitropin alfa, follitropin beta, menotropins,urofollitropin
    (Gonal-F, Follistim, Humegon, Pergonal, Repronex, Fertinex, Bravelle)
  • Kineret (Anakinra)
  • Lamisil (Terbinafine oral)
  • Penlac (Ciclopirox)
  • Raptiva (Efalizumab)
  • Sporanox (Itraconazole)
  • Human Growth Hormone
For most drugs, prior authorizations are valid for one year, so in most cases, you do not need to take additional action
to continue prior authorizations determinations that the previous TRICARE pharmacy benefit manager authorized for your TRICARE patients prior to June 1, 2004.

New prior authorization forms for both the TRRx and TMOP programs are available on the Express Scripts Web site (www.express-scripts.com/TRICARE) or by calling 1-866-DoD-TRRx or 1-866-DoD-TMOP.

TRICARE has a long-standing mandatory generic drug policy and will not pay for branded products when generic alternatives exist, unless a medical necessity is justified.

Centralized Customer Service
Under the new TRRx contract, Express Scripts handles all provider and beneficiary customer service questions
related to the TRICARE pharmacy benefit. A single retail pharmacy customer service line is now available at
1-866-DoD-TRRx (1-866-363-8779).

Providers are encouraged to inform patients that they should no longer contact TRICARE Service Centers (TSCs) for questions about the TRRx program and instead use the new customer service line above.

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