FAQS FOR SELECT SPECIALTY PHARMACY NETWORK 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: QUESTION: What is a specialty medication? ANSWER: 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: http://pec.ha.osd.mil/formulary_search.php Why do I have to change pharmacies? 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 effective? 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 pharmacy? 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 changing? 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® patients. 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 888.455.4342. 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 option? 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 http://www.express-scripts.com/TRICARE/homedelivery/specialty/ 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 prescription. 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 medications? 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 copayment. 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 delivery? 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 waivers? 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 infusions? Drugs provided by infusion services are not included in the Select Specialty Pharmacy Network. 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 information? 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.
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