[HEALTH.MIL] Tricare to No Longer Cover Some Prescription Pain Killers

  • From: HEALTH.MIL@xxxxxxxxxxxxx
  • To: <HEALTH.MIL@xxxxxxxxxxxxx>
  • Date: Tue, 17 Mar 2015 07:37:22 -0500

Tricare to No Longer Cover Some Prescription Pain Killers

rescription-pain-killers.html?comp=700001075741&rank=2#disqus_thread> 54


Mar 16, 2015 | by Amy Bushatz 

 <http://www.military.com/benefits/tricare> Tricare officials are rolling out a
new prescription drug clearance system that will block from coverage some
ingredients used in compounded medications like pain killers, officials
announced March 13.

The changes, which will go into effect May 1, are designed to cut the health
insurer's pharmacy costs by no longer paying for compounds they considers unsafe
or ineffective, Tricare officials said. They will most heavily impact
prescription pain killers, which make up the majority of compounded medication
filled by Tricare, they said.

A compounded medication is a drug mixed with one or more non-FDA approved
ingredients designed to alter the drug to fit the need of the person taking it.
For example, children often take compounded medications to alter the drug's
dosage to their weight, remove dyes to which they are allergic or turn a pill
medication into a liquid.

For pain management, compounds are often used to turn pain medications into
creams or sprays to target specific areas. Specialized compounding can also
adjust the dosage to the size or pain tolerance of the patient.

But a top Tricare official said in a Military.com interview that the
effectiveness of those specialized pain medications are not always "supported by
evidence." At least one Military Treatment Facility (MTF) has complained
recently about a marketing agent for a pain medication compounding pharmacy
soliciting potential customers in the MTF's pharmacy waiting room, he said.

"We've seen several examples where compounding pharmacies are trying to go out
and do direct marketing to patients," Dr. George Jones, Tricare's pharmacy chief
said. "Unfortunately there are some bad actors out there that have tried to
exploit this opportunity of interest in pain management with claims that may not
quite by supported with the evidence."

Compounding agents cost Tricare more than $514 million in 2014 and are on track
to exceed $2 billion for 2015, officials said. Yet those agents make up only 0.5
percent of the total number of prescriptions provided by Tricare. Tricare
currently fills compounded medication for about 40,000 users a month, Jones

The vast majority of compounded medications will continue to be covered, Jones
said. Although he declined to give an example of pain medication compounds that
will no longer be included, he said popular compounding agents such as
gabapentin and ketamine will still be covered. He was also not able to provide a
percentage the compounding agents that will still be covered.

Right now, Tricare chooses which compounded medications to cover based on the
screening of a single ingredient submitted by a pharmacy. But the new system
operated by Tricare's pharmacy subcontractor, Express Scripts, will allow
officials to screen every ingredient included in any given compound medication.
If all ingredients do not match the accept list, coverage will be denied, they

Tricare officials decided which compounding ingredients will be on the
ances/ucm377052.pdf> list based on FDA standards for compounding agents released
in July 2014, Jones said.

Ingredient screening will be instantaneous though the online Express Scripts
system. When an ingredient is denied, the pharmacist will be notified about
which one and given the option to call Express Scripts to explore alternatives.

Tricare users who wish to can file a "prior authorization" form and appeal to
Express Scripts after a denial. The appeal will be processed in no more than
five days, Jones said.

To avoid a disruption in service while Tricare processes drug appeals, officials
will pay for some no longer covered compounds on a case-by-case basis, Jones

Tricare users who have a have had a compounded medication filled in the last 30
days will soon receive a letter by mail notifying them of the change.


SOURCE:  Military.com article at
rescription-pain-killers.html?comp=700001075741&rank=2> &rank=2





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