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Co-pays to rise on 9 more Tricare drugs

The Defense Department is moving nine more medications to its highest price tier, which means they will cost Tricare beneficiaries $22 per prescription, officials announced Friday.

The medications that will move to Tricare’s $22 “third tier” are the allergy drugs Clarinex, Clarinex-D and Veramyst; the asthma drug Zyflo; and the growth hormones Genotropin, Genotropin Miniquick, Humatrope, Omnitrope and Saizen.

The growth hormones and Veramyst will move to the third tier Dec. 19, with Clarinex, Clarinex-D and Zyflo following Jan. 16.

The announcement is the latest in a series of changes to the Tricare formulary in recent years aimed at encouraging beneficiaries to use less costly generic drugs when possible.

Prescriptions for medications in the formulary — the official list of drugs offered through the Tricare Pharmacy Program — listed on the third tier carry a beneficiary co-payment of $22, regardless of whether the drug is purchased at a Tricare network retail pharmacy or through the Mail-Order Pharmacy Program.

In contrast, the co-pay for first-tier medications — generic drugs — is $3 for a 90-day supply if purchased through the mail, and the same for a 30-day supply purchased at a Tricare network retail pharmacy.

For second-tier drugs — brand-name medications with no generic equivalent — the co-pay is $9 for a 90-day supply through the mail, and the same for a 30-day supply from a Tricare network retail pharmacy.

Beneficiaries can get a price break on third-tier drugs if their doctor certifies that a specific medication on that tier is medically necessary. If so, the co-payment drops to $9.

Third-tier medications are not available at military treatment facility pharmacies unless an MTF provider certifies a medical necessity for the drug and writes the prescription.

Tricare keeps a complete online list of drugs, their formulary status and where they are available at http://www.tricareformularysearch.org/dod/medicationcenter/default.aspx.

More information on the Tricare retail and mail-order pharmacy programs is available online at http://www.express-scripts.com/tricare or by calling toll-free (866) 363-8779 for the retail pharmacy or (866) 363-8667 for the mail order pharmacy.

More information about the Uniform Formulary Beneficiary Advisory Panel review process, which advises Defense Department health officials on potential changes to the formulary, is online at http://www.tricare.mil/pharmacy/BAP.