TRICARE beneficiaries filling specialty medication prescriptions at retail pharmacies should begin moving those prescriptions to Accredo, which will be the primary in-network pharmacy option for specialty medications as of Jan. 1, 2023.
The TRICARE Home Delivery Program and military treatment facility (MTF) pharmacies will continue to be available for some specialty medications, but Accredo will be the only retail specialty pharmacy option for most specialty prescription drugs, which are used to treat chronic, complex conditions such as cancer, rheumatoid arthritis, multiple sclerosis, and hepatitis C. They sometimes require clinical training to administer and may need special handling, storage, and patient monitoring.
Only 1% to 2% of TRICARE beneficiaries take specialty medications. Impacted beneficiaries should have received a letter from Express Scripts notifying them of this change. You can also check the specialty drug list on the TRICARE website to verify if any of your medications are specialty drugs.
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To fill your specialty medications at Accredo, call 1-877-882-3324 and an Accredo patient care advocate will work with you and your doctor. Accredo provides 24/7 access to personalized care and support from specialty-trained pharmacists and nurses.
Your medication also may be eligible for home delivery from Express Scripts; call 1-877-363-1433 to find out.
You also can check with your local MTF pharmacy to see whether it stocks your specialty medication on their formulary. If you are receiving your specialty drug through home delivery or an MTF pharmacy, you don’t need to make any changes.
Specialty drugs represent a significant and growing portion of TRICARE pharmacy spending. From FY 2018 to FY 2021, TRICARE specialty drug spending increased 43% from $2.360 billion to $3.369 billion. In FY 2021, specialty drugs accounted for less than 1% of military health system (MHS) prescription drug utilization, but 47% of MHS drug spending.
Although the cost of specialty drugs is high, some represent significant advances in therapy. The high price may be offset by decreases in future medical costs.
[RELATED: MOAA’s TRICARE Toolkit]
The current TRICARE specialty drug retail network is already very narrow and includes Accredo, Kroger, Rite Aid, and Walgreens. Consolidating TRICARE retail specialty drug dispensing at Accredo will reduce TRICARE’s growing pharmacy spending by allowing DoD to leverage the National Prime Vendor procurement/replenishment model, which provides discounted pricing on specialty drugs.
MOAA supports efforts to control TRICARE costs but only if beneficiaries retain access to high quality care. Have you been impacted by this change to the specialty drug network? If so, please share your story with us at firstname.lastname@example.org.
Have More Questions About Your Health Care Benefit?
MOAA's TRICARE Guide answers some commonly asked questions.