By John Brooks
Defense Health Agency dispensing policies were recently changed to prohibit Military Treatment Facility Pharmacies from filling Department of Defense Tier 3 medications for TRICARE beneficiaries who are not enrolled with an MTF.
“MTF pharmacies will not fill non-formulary (DoD Tier 3) medications from non-MTF providers unless the patient has been referred to that provider by the MTF,” according to DHA POD-MEMO 19-001, dated July 10.
DoD Tier 3 medications are non-formulary medications — medications which are not on the Uniform Formulary, the list of medications regularly procured by MTF pharmacies.
Examples of DoD Tier 3 (non-formulary) medications include Lyrica, Nexium, Symbicort, Cialis and Vyvanse.
The TRICARE Uniform Formulary can be found at https://www.express-scripts.com/tform/index.html.
“Tier 3 medications and specialty medications can best be identified by calling the GLWACH hospital or PX pharmacy where pharmacists, and technicians are ready to assist patients to identify which medications fall under this policy,” said Capt. Paul Chin, GLWACH’s Pharmacy Service Line acting chief.
Prescriptions written by off-post providers can only be filled at GLWACH pharmacies if the patient was referred to the off-post provider by their MTF primary care team.
“If your PCM is with GLWACH and you were referred out to an off-post specialist, and that off-post provider writes you a script for a Tier 3 (non-formulary) medication, it can be filled at GLWACH as long as the medication meets Tricare’s medical necessity criteria,” Chin said.
The memo also states MTFs are exempt from dispensing medications only available at specialty pharmacies.
Specialty medications are any medications which are not stocked by the MTF supplier, hence only available through other channels.
“If the medication is only available through specialty pharmacies, then we cannot order the medication for the patient. In this case, the medication can only be procured through either the Tricare Mail Order Specialty Pharmacy or a local specialty pharmacy of the patients’ choice,” Chin said.
The Tricare Mail Order Specialty Pharmacy offers a 90-day supply of specialty medications with a co-pay of $53. Specialty medications obtained from a local specialty pharmacy are only available in a 30-day supply with a co-pay of $53.
The new policy also encourages an implementation plan that incorporates patient communication and support to prevent a gap in patient care.
“MTF pharmacies are encouraged to educate patients about the requirement to use the Home Delivery Pharmacy instead of Retail Pharmacies for obtaining most non-formulary (Tier 3) medications,” the memo reads.
The GLWACH Pharmacy will assist patients through these changes to the fullest extent allowable, Chin said.
“If you so choose, a GLWACH pharmacist can have a discussion with your off-post provider to have the medication changed to one that is eligible to be filled at GLWACH Pharmacies,” Chin said. “Alternatively, we can contact your off-post provider to issue the prescription to the Tricare Express Scripts Mail Order Pharmacy or a retail network pharmacy.”
“Please do not hesitate to visit or contact us so we can help you understand these changes and navigate through them,” Chin said.
This topic will be addressed again at the next GLWACH Town Hall meeting, scheduled for 1 p.m., Monday, Sept. 9, in GLWACH’s MEDDAC Classroom. Everyone is invited to GLWACH Town hall meetings, which are held on the second Monday of each month at 1 p.m. in the GLWACH MEDDAC Classroom.
TRICARE beneficiaries are always welcome to contact the GLWACH main Pharmacy at 573.596.0514, or the PX Pharmacy at 573.596.3234, or email the GLWACH pharmacy at firstname.lastname@example.org with their questions.
TRICARE beneficiaries who wish to enroll at GLWACH should contact HealthNet Federal Services at 844.866.9378 or enroll online at https://tricare.mil/milconnect. Active Duty Service Members are responsible for contacting HNFS to enroll their family members here.
GLWACH’s automated medication refill phone number is 573.596.0128 or 800.245.1953, and the on-line pharmacy refill link is available at https://www.tricareonline.com. To make an appointment with your GLWACH PCM, call the TRICARE appointment line at 866.299.4234.
(Editor’s note: Brooks the General Leonard Wood Army Community Hospital marketing and public affairs officer.)