So what are specialty drugs? Specialty drugs treat long-term complex conditions, like multiple scleroses, rheumatoid arthritis, hepatitis C, and cancer. Specialty drugs are normally self-administered, injectable, or oral. Sometimes they can require clinical training to administer and may need special handling and refrigerated storage.
“Specialty drugs are essential for a lot of the beneficiaries we serve,” said Lt. Col. Melissa Yates, pharmacist with the TRICARE Pharmacy Operations Division. “The updates to TRICARE’s pharmacy network will give military families, who are dealing with complex and chronic health conditions, more support in managing their medication therapy.”
Read through the Q&A to learn more about the changes you can expect with the pharmacy network.
Q: Will I have to change my pharmacy if I don’t get my specialty drugs from an Accredo specialty pharmacy?
A: To avoid paying increased out-of-pocket costs, you must move to a specialty pharmacy in the network. Make sure you act on or before Jan. 1, 2023.
The TRICARE pharmacy network where you may obtain specialty drugs will include:
- Accredo specialty pharmacies
- Certain retail specialty pharmacies
- TRICARE Pharmacy Home Delivery
- Military pharmacies
Q: How are specialty drugs defined or identified?
A: TRICARE will continue to define specialty drugs and maintain the Specialty Care Drug List. You’ll also still be able to look up your drugs and see where they’re available using the TRICARE Formulary Search Tool. Make sure you review the specialty drugs list and the search tool for updates after Jan. 1.
Q: Can I use TRICARE Pharmacy Home Delivery after January to get my specialty drugs delivered?
A: Yes, but TRICARE Pharmacy Home Delivery may not stock your specialty drugs. Check the TRICARE Formulary Search Tool or contact Express Scripts to see if home delivery supplies your drug. If you’re currently receiving your specialty drug through home delivery, you can stay at that pharmacy. You don’t need to make any changes.
Q: Will my copayments change?
A: If you move your specialty drug from home delivery to Accredo, then your copayments will change. You’ll pay the retail network pharmacy copayments. If you move from a retail network pharmacy to Accredo, then your copayments will stay the same. And deductibles may still apply. If you fill your specialty drugs at a military pharmacy or through TRICARE Pharmacy Home Delivery, then nothing changes for you.
The TRICARE Pharmacy Program Overview Fact Sheet states that pharmacy costs are based on who you are, the prescription drug category, and where you fill your prescription. You can view your current pharmacy copayments on the TRICARE website.
Q: How do I switch to Accredo?
A: To fill your specialty drugs at Accredo, log in or register online at www.express-scripts.com/login/tricare. You can also call Accredo at 1-877-882-3324. A patient care advocate will work with you and your doctor to get a new prescription sent to Accredo. Since Accredo is part of the pharmacy network right now, you can move your specialty drugs ahead of Jan. 1. Moving now will help avoid disruptions and increased out-of-pocket costs if you use a non-network pharmacy.
If you need help finding a pharmacy to fill your specialty drugs, visit Express Scripts. To learn more about TRICARE’s coverage of specialty drugs, go to the covered services page.
The TRICARE retail pharmacy network changed on Oct. 24; learn about the changes.
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November 01, 2022 at 09:23PM
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