TRICARE has announced the addition of 11 new medications to the TRICARE Uniform Formulary.

Additionally, they approved moving seven medications to non-formulary status.

The following medications have been added to the Uniform Formulary: Levitra (PDE-5 Inhibitor); nystatin, clotrimazole, ketoconazole, miconazole, Mentax, Naftin (Topical Antifungals); and Rebif, Avonex, Copaxone, Betaseron (Multiple Sclerosis Disease Modifying Drugs).

The non-formulary medications include: Viagra, Cialis (PDE-5 Inhibitors); and ciclopirox, econazole, Oxistat, Ertaczo, Exelderm (Topical Antifungals).

Formulary alternatives are available for these medications at a co-pay of either $3 or $9. Beneficiaries will pay $22 for up to a 30- or 90-day supply for non-formulary medications, depending on whether they fill the prescription at a TRICARE Retail Network Pharmacy (TRRx) or through the TRICARE Mail Order Pharmacy (TMOP). Beneficiaries will pay the higher of $22 or 20 percent in retail non-network pharmacies. The implementation date of the $22 co-payment for the topical antifungal medications is Aug. 17, 2005, and the implementation date for PDE-5 Inhibitors is Oct. 12, 2005.

Patients currently using the newly designated non-formulary medications may wish to consult their doctor about formulary alternatives or if a medical necessity is appropriate for them. If medical necessity is established for using non-formulary medications, patients may qualify for the $9 co-payment for up to a 30-day supply or up to a 90-day TRICARE Mail Order Pharmacy (TMOP) supply.

Medical necessity forms are available on the TRICARE Pharmacy Website Procedures for completing and submitting medical necessity information may be found on these forms. For more information about TMOP, eligible beneficiaries may visit the Express-Scripts Inc. Website, or they may call (866) DOD-TMOP, (866) 363-8667. Beneficiaries may also contact the TRICARE Retail Pharmacy Program TRRx customer service line at (866) DOD-TRRX, (866) 363-8779, or visit the TRICARE Pharmacy Website. For additional information about various medications, their availability and cost, beneficiaries may use the TRICARE Formulary Search Tool.

Cost Share and Availability of Non-Formulary Medications at Retail Network Pharmacies or the Mail Order Program
- Non-active duty military beneficiaries will pay $22 for up to a 30 or 90-day supply of non-formulary medications, depending on whether they fill the prescription at a TRICARE Retail Network Pharmacy (TRRx) or through the TRICARE Mail Order Pharmacy (TMOP). Non-active duty beneficiaries will pay the higher of $22 or 20 percent in retail non-network pharmacies. Non-active duty beneficiaries may fill prescriptions for non-formulary medications at the lower formulary cost share ($9) if the non-formulary medication is determined to be medically necessary. Active duty service members pay no cost shares, and unless medical necessity is established, they may not obtain non-formulary medications.

Availability of Non-Formulary Medications at Military Treatment Facilities (MTFs)
- MTFs are prohibited from having medications designated as non-formulary on the Uniform Formulary on their local formularies. MTFs will be able to fill non-formulary requests for these medications only if both of the following conditions are met: 1) an MTF provider writes the prescription, and 2) medical necessity is established for these products. MTFs may (but are not required to) fill a prescription for a non-formulary medication written by a non-MTF provider to whom the patient was referred, as long as medical necessity has been established. Active duty service members may not obtain non-formulary medications unless medical necessity is established.