Specialty Tier

The specialty tier is a classification within TRICARE's pharmacy benefit for high-cost specialty medications used to treat complex conditions. These drugs often require special handling, administration, or monitoring and are typically biologics or other advanced therapies.

Characteristics of specialty tier drugs: • High acquisition cost • Often injectable or infusible medications • May require special storage (e.g., refrigeration) • Typically treat complex or rare conditions • May require administration by a healthcare professional

TRICARE specialty pharmacy program: • Managed through Express Scripts specialty pharmacy • Prior authorization typically required • Care coordination and clinical support provided • Home delivery available for self-administered specialty drugs • Some specialty drugs must be obtained through the specialty pharmacy

Conditions commonly treated with specialty drugs: • Cancer and oncology • Rheumatoid arthritis and autoimmune diseases • Multiple sclerosis • Hepatitis C • HIV/AIDS • Growth hormone deficiencies

Work with your provider and Express Scripts to understand coverage requirements and cost-sharing for specialty medications.