Specialty medication care management

Specialty medications are usually high-cost, self-administered, injectable, oral or infused drugs that treat serious chronic conditions (e.g., multiple sclerosis, rheumatoid arthritis, hepatitis C). These drugs typically require special storage and handling and are not readily available at local pharmacies.

Specialty medications may also have side effects that require pharmacist and/or nurse monitoring. Specialty medication care management is structured to improve the beneficiary’s well-being.

This program provides:

  • Access to proactive, clinically based services for specific diseases designed to help beneficiaries get the most benefit from their medications
  • Monthly refill reminder calls
  • Scheduled deliveries to beneficiaries’ specified locations
  • Specialty consultation with a nurse or pharmacist at any point during therapy

These services are provided to beneficiaries at no additional cost when they receive their medications through TRICARE Pharmacy Home Delivery and participation is voluntary. If a patient orders a specialty medication from TRICARE Pharmacy Home Delivery, Express Scripts sends the patient additional information about the specialty medication care management program and how to get started. Beneficiaries enrolled in this program have access to pharmacists 24 hours a day, seven days a week. The specialty clinical team contacts the beneficiaries’ physicians to address beneficiary issues such as side effects or disease exacerbations. If any patients currently fill specialty medication prescriptions at retail pharmacies, the specialty clinical team will provide brochures detailing the program as well as prepopulated enrollment forms.

If a patient requires specialty pharmacy medications, fax the prescription to TRICARE Pharmacy Home Delivery at (877) 895-1900. TRICARE will ship medications to the beneficiary’s home. Faxed prescriptions must include the following ID information: patient’s full name, date of birth, address and ID number.

Note: Some specialty medications may not be available through TRICARE Pharmacy Home Delivery because the manufacturer limits the drug’s distribution to specific pharmacies. If providers submit a prescription for a limited-distribution medication, TRICARE Pharmacy Home Delivery either forwards the prescription to a pharmacy of the patient’s choice that can fill it or provides the patient with instructions about where to send the prescription. Determine if a specialty medication is available