Network and Provider Solutions offers the above listed Network Specialty Pharmacies for use by our South Region Providers for TRICARE beneficiaries. Specialty Pharmacies are not retail pharmacy providers and much of what they offer is a part of the TRICARE medical benefit, not pharmacy benefit. Several of the listed specialty pharmacies include a “drug list or formulary”, all others listed without a formulary expect the provider to contact directly to determine if a particular drug/item is available to order. Beneficiaries are not allowed to contact one of the Specialty Pharmacies as it is not retail, but available for physician order only. The process includes a prescription/referral form with a fax number the provider must submit per TRICARE patient, per episode of care. Why is this a value add for providers? The specialty pharmacy selected for the service takes the responsibility to bill the drug item directly to the TRICARE claims processor. This alleviates the ordering provider from having to file the drug portion of the claim with the NDC# and unit/dosage amount per injection. All the provider has to file is the patient visit or admin fee for the same date of service.
Our newest additions for providers to obtain IUDs and several pediatric vaccines come from SkyeMed, one of our premier specialty pharmacies.
J7301 – Skyla IUD (as of June 1st)
J7302 – Mirena IUD (since Nov. 2014)
90670 – Prevnar 13 (vaccine) NEW as of July 1st.
90680 – Rotavirus Vaccine (3 dose) NEW as of July 1st.
90681 – Rotavirus Vaccine (2 dose) NEW as of July 1st.