Does anyone have a contact that could help with major issues I am having with Express Scripts (Tricare prescription plan)?

SSG Private RallyPoint Member — Mon, 13 Sep 2021 10:25:34 -0400

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.

Response by Lt Col Jim Coe made Sep 13 at 2021 10:48 AM

Lt Col Jim Coe — Mon, 13 Sep 2021 10:48:46 -0400

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.

Response by MAJ Ronnie Reams made Sep 13 at 2021 11:25 AM

MAJ Ronnie Reams — Mon, 13 Sep 2021 11:25:05 -0400

Doc should be able to get the MTF pharmacy to get it for you. Free, too.

Response by SCPO Edward Westerdahl made Sep 13 at 2021 12:25 PM

SCPO Edward Westerdahl — Mon, 13 Sep 2021 12:25:54 -0400

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.,

Response by SSG Laurie Mullen made Sep 14 at 2021 1:55 AM

SSG Laurie Mullen — Tue, 14 Sep 2021 01:55:38 -0400

I read through the responses, can you get TriCare to pay for it through a pharmacy? I don't use Express Scripts, I pay a little more to get my meds through a brick and mortar pharmacy. Have you tried that?