Compound Drugs

Compound drugs are:

  • A combination of two or more drugs
  • Prepared by a pharmacist
  • For a patient’s individual needs

We are changing our process for compound drugs on May 1, 2015.

  • We’ll start screening individual ingredients in compound drugs like we do for all other prescriptions.
  • If you have a current prescription for a compound drug affected by the change, you’ll get a letter from Express Scripts explaining your options.
  • If you're not sure if your prescription is affected, call Express Scripts at 1-877-363-1303.

New Screening Process

Step 1: Electronic Screen

Express Scripts will electronically screen each ingredient to make sure:

  • TRICARE covers it
  • It’s safe and effective
  • It doesn’t exceed the cost standard

This step usually takes less than 5 seconds to complete.

Step 2: Required if the Compound Doesn’t Pass Step 1

If the compound drug—or any ingredient in it—doesn’t pass the first step, your pharmacist can:

  • Remove or substitute the non-covered ingredient with a covered ingredient.
  • Contact your doctor to request a different drug to treat your condition.

This step happens while you wait at the pharmacy.  It may take 15-20 minutes.

Step 3: Prior Authorization

Your doctor can request prior authorization for the compound drug if they can’t substitute an ingredient or prescribe a different drug for you. To request prior authorization:

  • Download the Compound Drug Prior Authorization Form (available soon) 
  • Give it to your doctor to complete and submit to Express Scripts (instructions will be on the form)

This step usually takes about 5 days from when Express Scripts gets all the necessary  paperwork.

If your compound drug doesn’t get approved, you have 90 days to request a formal appeal.

More Information

For more information, you can:

If you're not sure if your prescription is affected, call Express Scripts at 1-877-363-1303.

Last Updated 3/19/2015

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Express Scripts, Inc.

Stateside: 1-877-363-1303
Overseas: 1-866-275-4732
(where toll-free service is established)

Express Scripts Website

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