How does TRICARE cover specialty medications?
Quick Answer
Specialty medications for complex conditions are covered through Accredo specialty pharmacy with prior authorization and may have assistance programs.
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Key Takeaways
- Specialty meds need authorization
- Accredo is specialty pharmacy
- Nurse support available
- Copay assistance may apply
Detailed Answer
Specialty medications are high-cost drugs for complex conditions.
What Are Specialty Medications
- Biologics (injections)
- Medications for cancer, MS, RA
- Drugs requiring special handling
- Often self-injected at home
How to Get Specialty Meds
- Prior authorization required
- Dispensed through Accredo
- Specialty pharmacy coordination
- Delivered to home or provider
Costs
- May be non-formulary tier
- Copay assistance may apply
- Counts toward catastrophic cap
- Some have manufacturer assistance
Prior Authorization
- Provider submits request
- Clinical criteria reviewed
- Usually required
- Renewals needed periodically
Accredo Services
- Medication delivery
- Nurse support available
- Education about medications
- 24/7 pharmacist access
Related TRICARE Terms
Related Questions
What services require prior authorization?
Prior authorization is needed for many inpatient stays, some surgeries, specialty services, DME, and certain high-cost procedures regardless of plan.
What is the TRICARE formulary?
The TRICARE formulary is the list of covered medications organized into tiers, with generic drugs in lowest tier and specialty drugs in highest tier.
What do most military families add to their TRICARE coverage?
Supplemental health insurance is the most common addition — it covers dental, vision, and out-of-pocket costs that TRICARE leaves uncovered. Life insurance and a legal will are also highly recommended.
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