Specialty FAQ`s - Express Scripts

Your wellbeing is very important to TRICARE® and Express Scripts. We want to make sure you receive
the medication(s) you need and the special care you deserve. Listed below are Frequently Asked
Questions that may help you to better understand the change in your pharmacy benefit:
What is a specialty
Specialty medications are usually high cost, self-administered, injectable or oral medications
that treat serious, chronic conditions (for example, cancer, multiple scleroses, rheumatoid
arthritis, hepatitis C and others).
Beneficiaries enrolled in TRICARE® Pharmacy Home Delivery are eligible to have these
prescription drugs (if available at Home Delivery) mailed directly to their homes and to
receive additional care through TRICARE’s Specialty Medication Care Management Program
at no cost to the beneficiary. A list of DoD Specialty Medications can be found at:
Why do I have to change
Your health and well being is important to TRICARE and Express Scripts. The new Select
Specialty Network will provide high touch quality care from these pharmacies with expertise
in managing the conditions requiring specialty medications. Moving to a smaller network of
select pharmacies that provide specialty medications is a way to potentially improve health
outcomes and help control costs.
When is this change
The effective date of the change is May 1, 2015. You will need to make sure your specialty
medication is transferred before that date.
How will I be notified of
this change in my network
Beginning in February, 2015, letters will be mailed to beneficiaries who currently receive
specialty medications. The letters will list options for obtaining specialty medications in the
preferred pharmacy network. You can call 1-877-363-1303 if you have any questions.
If you attempt to fill your prescription after May 1, 2015 and your pharmacy is out of
network, your pharmacist will let you know that the prescription will need to be filled at an
in network specialty pharmacy. A phone number to call will be provided at that time for a
list of in network specialty pharmacies and any additional questions you may have. You may
also call 1-877-363-1303 if you have questions.
TRICARE is a registered trademark of the Department of Defense, Defense Health Agency. All rights reserved.
Will my doctor understand
my pharmacy network is
Simultaneously, your doctor will also receive a letter from Express Scripts explaining that
the specialty pharmacy networks are changing effective May 1, 2015 for their TRICARE®
What are my options to get
my specialty medications?
We’ve made sure there are several ways for you to get your specialty medication(s).
Choose from one of the options below:
 Through TRICARE Pharmacy Home Delivery, serviced by Express Scripts with our
Specialty Care Management Program provided at no cost to you. This document has
more information about TRICARE Pharmacy Home Delivery or you can call
 At a retail pharmacy. Beginning May 1, 2015, the specialty network for TRICARE
beneficiaries will be made up of Wal-Mart, CVS, Target, and Rite-Aid.
You may also use Accredo, a nationwide specialty mail pharmacy. For more information
about using Accredo, please call 800.803.2523.
 From your Military Treatment Facility (MTF). Please call the local MTF Pharmacy to
make sure they have your medication.
What happens if I don’t
change my pharmacy
If you choose to use an out of network pharmacy, the out of pocket expense you will pay
will be reimbursed at non network rates.
I thought my pharmacy was
already a network
pharmacy. Why can I no
longer use it?
Your pharmacy may be in the network for drugs other that drugs considered to be specialty
drugs for your benefit. The drugs considered to be specialty drugs can be viewed online at
Can I expect any service
improvements from my
new pharmacy?
If you choose to use TRICARE Pharmacy Home Delivery, you will receive services through
the Specialty Medication Care Management Program that is free to you and complements
the care provided by your doctor. You’ll get:
 Professional and confidential consultation with experts who understand your condition
 Refill reminder calls each month
 Access to a pharmacist 24 hours a day, 7 days a week to discuss potential drug
interactions or side effects, as well as answer any questions you may have about your
 Nurses who can discuss your progress and help you receive the greatest benefit from
your medication
 Guidance on how to take specialty medications correctly
 Support in managing your medication therapy
 Personal care through patient care advocates
 Access to educational materials to help you manage your condition
TRICARE is a registered trademark of the Department of Defense, Defense Health Agency. All rights reserved.
How do I enroll in TRICARE®
Pharmacy Home Delivery
for my specialty
Getting started is easy. Call us and we’ll take care of everything for you.
Call 888.455.4342 to talk with a patient care advocate who will arrange delivery of your
medication(s). Hours are from 7 a.m. to midnight, Eastern; Mon. through Fri.; 7 a.m. to
9 p.m. on weekends and holidays (TTY 877.540.6261). Or you can sign up online, by mail
or by fax from your doctor.
Online — Log in to Express-Scripts.com/TRICARE*. Your prescriptions being filled at
your retail pharmacy will be automatically displayed on the home page. For any
medication that displays a purple “Transfer to Home Delivery” option, click the button,
then select the item and click “add to cart.” After you add your retail medication to the
cart, you will need to go through the checkout process in order to finalize the transfer
to Home Delivery. Express Scripts will then reach out to your doctor to receive their
approval. If you have questions or need help, please call a Patient Care Advocate at 1877-363-1303. We recommend you have a 30-day supply of medication on hand while
your first order is being processed.
*First-time visitors will need to register. Simply click, “Create an Account” to register. Have
your beneficiary ID number handy.
Mail — Get a prescription from your doctor, and mail it to Express Scripts at the
address below:
Express Scripts
PO Box 52150
Phoenix, AZ 85072-9954
A patient care advocate will call you to arrange delivery of your medication(s). Include
the following information with your prescription: Beneficiary name, complete address,
phone number, birth date and sponsor ID. You will be billed later if you have a
Fax – Ask your doctor or nurse to fax your new prescription (with a fax cover sheet)
directly to Express Scripts at 877.895.1900. Note: Faxes can only be accepted from
your healthcare provider’s office.
Do I have to get all my
medications through the
reduced network or home
No. The broader TRICARE Pharmacy Network can fill non specialty drugs. The pharmacies in
the specialty network can fill both specialty drugs and non specialty drugs.
What do I have to do to get
my medications transferred
to the new pharmacy?
To avoid any interruption in your service, move your prescriptions to a new pharmacy
before May 1, 2015, by doing one of the following:
 Call or visit the new pharmacy in your specialty network and talk to the pharmacist
about having your prescription transferred.
 Ask your doctor to call the new pharmacy with your prescription information.
 Call TRICARE Pharmacy Home Delivery at MCC and we will contact your doctor for you.
TRICARE is a registered trademark of the Department of Defense, Defense Health Agency. All rights reserved.
What if I am a TRICARE® For
Life (TFL) beneficiary?
As a TRICARE For Life beneficiary you may be required to move some of your medications to
TRICARE Pharmacy Home Delivery. The change in the specialty network will not affect those
medications. There may be other specialty medications that you use which are not a part of
the TRICARE For Life Pilot. Those medications may need to move to the new specialty
network. Please call the Customer Service Center at 1.877.363.1303 with any specific
questions about your benefit.
Are there any exceptions or
No, you must get all affected specialty drugs from either a specialty network pharmacy or
Home Delivery.
How do I compare
pharmacy option costs?
Visit www.tricare.mil/pharmacycosts
My current specialty
pharmacy also provides
infusion services. If I no
longer use this pharmacy,
who will administer
Drugs provided by infusion services are not included in the Select Specialty Pharmacy
My current specialty
pharmacy safely takes away
and discards all expired
drug. Will I be responsible
for this now?
Drugs provided by infusion services are not included in the Select Specialty Pharmacy
Network. If you have any other drug disposal questions, please contact your pharmacy.
Where can I get more
Visit www.express-scripts.com/TRICARE to see a list of specialty pharmacies. If you have
general questions about your pharmacy benefit, please call the Customer Contact Center at
877.363.1303. You can also call Member Choice Center at 888.455.4342 to enroll directly
into TRICARE Pharmacy Home Delivery.
TRICARE is a registered trademark of the Department of Defense, Defense Health Agency. All rights reserved.