View Full Version : Two more drugs switched to nonformulary list

11-14-06, 01:20 PM
November 06, 2006
Two more drugs switched to nonformulary list

By Gayle S. Putrich
Staff writer

If you get your prescription drugs through Tricare, it will be a little more expensive to keep your cholesterol down next year.

Crestor and Caduet — both cholesterol-lowering medications — will move to “third-tier,” or nonformulary, drug status under Tricare as of Feb. 1, 2007, a change that will bump their price to $22 for a 30-day supply.

Medications on the first tier of the formulary — usually generics — are available at $3 for a 30-day supply from brick-and-mortar Tricare retail pharmacies and $3 for a 90-day supply through Tricare’s mail-order system. Drugs on the second tier — which include the two cholesterol medications — are $9 for a 30-day supply in retail pharmacies and the same price for a 90-day supply through the mail-order program.

A 30-day supply of third-tier drugs costs $22 through either channel.

Moreover, co-pays for any drug tier may be higher at retail pharmacies outside the Tricare network, health officials warn.

In some cases, patients can still get third-tier drugs at first- or second-tier co-pay rates. If no comparable generic alternative exists, or if there are medical reasons for prescribing a specific medication that is no longer on the formulary, it can still be obtained at the lower prices. But patients must get prior authorization from a doctor that the specific higher-priced drug is medically necessary before Tricare will grant the price break.

Different parts of the formulary are evaluated each quarter by the Defense Department's Pharmacy and Therapeutics Committee. Made up of doctors, pharmacists and representatives from the Department of Veterans Affairs, the committee conducts a clinical review of the safety, effectiveness and clinical outcomes of various drugs, and also reviews prices for cost-effectiveness.

Having a third tier of higher-priced drugs is a development of the past 18 months or so, said retired Air Force Col. Steve Strobridge, government relations director for the Military Officers Association of America.

Strobridge said the push is due to the ever-increasing costs of prescription drugs, a major factor in the upward spiral of the Pentagon’s health care budget.

“It’s the most expensive [drugs] that are being moved” to the third tier, he said.

The Pentagon’s view is that if a cheaper drug is just as effective as its brand-name counterpart, it makes sense from a cost standpoint to steer people to those drugs. The government also gets a federal discount on some medications, making it even cheaper to fill Tricare prescriptions for those drugs.

Strobridge said the MOAA and other military and veterans’ groups have not objected to most of the recent formulary changes. But there has been a problem getting the word out on the changes in a timely manner.

The Defense Department “isn’t giving people who are on these drugs sufficient notice that the drug is being moved to the third tier,” he said.

Many don’t find out about such changes until they’re in line at a pharmacy and the price rings up as $22 instead of $9, he said.

“We need longer lead times, so we can get the message out,” Strobridge said.

The last formulary change was announced in August and raised the price of five birth control drugs. On Jan. 24, Seasonale, Ovcon-35, Ovcon-35 chewables, Ovcon-50 and Estrostep Fe will move to the third tier and the higher price.