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