Posted on Sep 13, 2021
Does anyone have a contact that could help with major issues I am having with Express Scripts (Tricare prescription plan)?
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I have tried to work through an issue with getting a medication approved for 6 weeks now. Followed all the steps and tried 3 types of the specific medication... still denied. I have tried to reach out through all the communications posted on the Tri-care express scripts site, denial letters, emails, etc... and can not seem to get anyone that can truly help me or my Dr. understand what they need to see to approve treatment. Any help or suggestions would be great, thanks.
Healthcare
Veterans Affairs (VA)
Medical
Posted 3 y ago
Responses: 4
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Try this:
-Assign your doctor or a technician who works for your doctor as power of attorney representing you with regard to the TRICARE claim. Dr's office should have a form letter for this.
-The Doctor or Technician representing you disputes the denial of coverage on your behalf. Because the Dr speaks medicalese he or she can say all the correct words to convince the TRICARE authorities that the medication is a medical necessity.
-If your Doctor or personnel in their office are unfamiliar with this procedure, ask them to consult with another (larger) physicians' office in your local area. Cardiologists have to deal with this issue with TRICARE, so that might be a good place for your Doctor to start.
-If your Doctor or personnel in their office can't find a local physician's office to talk with, ask them to contact Missy at Dr Hatim Mahmood's office, [login to see] . Missy is a med tech, but she knows how this procedure works with TRICARE. Worked for me. You can use my name.
-Assign your doctor or a technician who works for your doctor as power of attorney representing you with regard to the TRICARE claim. Dr's office should have a form letter for this.
-The Doctor or Technician representing you disputes the denial of coverage on your behalf. Because the Dr speaks medicalese he or she can say all the correct words to convince the TRICARE authorities that the medication is a medical necessity.
-If your Doctor or personnel in their office are unfamiliar with this procedure, ask them to consult with another (larger) physicians' office in your local area. Cardiologists have to deal with this issue with TRICARE, so that might be a good place for your Doctor to start.
-If your Doctor or personnel in their office can't find a local physician's office to talk with, ask them to contact Missy at Dr Hatim Mahmood's office, [login to see] . Missy is a med tech, but she knows how this procedure works with TRICARE. Worked for me. You can use my name.
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Lt Col Jim Coe Thank you, sir! I will pass this onto to doctor. I greatly appreciate this!
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Call Express Scripts directly and talk to a Pharmacist. They can prescribe some drugs that are not in the TRICARE Formulary. You just have to pay more than $10 per 90-day script.,
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SCPO Edward Westerdahl Thanks, I have talked with them as well and they said due to the nature of the drug, they can not prescribe it... the crazy part is that the drug is not anything special or crazy... like there is no way to get a high from it and it has zero street value of any kind... it is strictly due to pricing ... and we have tried the generic form... just keep getting doors shut on us at every turn. thank you for taking the time to reposnd!
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MAJ Ronnie Reams Sir, that would work if I was active or lived close enough to a base. I am guard and we do not have that option here ... just another thing I miss about being active ...
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