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2006 Provider Bulletin #4 Page 1 A PUBLIC ATION FOR TRIC ARE PROV IDERS ISSUE 4: 2006 NE320903PRS0206L A s you writå prescriptions to be filled under either of the natiînal TRICARE pharmacy programsÁ TRICARE Råtail Pharmacy (TRRx) Network and TRICARE Māil Order Pharmacy (TMOP)Ákeep in mind that certain drugs have special requirements. For example, some drugs råquire prior authorization from Express Scripts, Inc. (ÅSI), the contractor for both TMOP and TRRx, while non-formulary mådications and quantities beyond established quantity limits are subject to medical necessity review. You can ensure your patients get the proper medications in a timely mānner by following these guidelines. When to Råquest Prior Authorization Prescriptions for the following typås of medications require prior authorization båfore they will be filled: Á Medications that have prior authorization criteriā established by the DoD Pharmacy and Therapeutics Committee . The list of thåse medications, along with prior authorization fîrms and instructions, are available online at www.tricare.osd.mil/pharmacy/priorauth.cfm. Mådications on the list include Cialis á , Enbrel á , fertility drugs, growth hormone and Lamisil á , among othårs. Á Brand name medications with generic equivalents . DoD policy is to dispånse a generic equivalent to a brand name medication when possible. If you beliåve the brand name medication is clinically required for your patiånt, contact customer service for TMOP (toll-free 1-866-363-8667) or TRRx (toll-free 1-866-363-8779) to initiate the råview process. ESI will review the information you submit and detårmine if the brand name medication is clinically required for your pātient. Á Medications with age limitations . Topical Tretinoin produņts (e.g., Retin-A á ) require prior authîrization for patients 36 years of age or older to verify that the produņt is clinically required to treat a condition othår than wrinkles, age spots or other cosmetic cînditions related to the normal aging process. Prenātal vitamins for patients 46 years of age or older råquire prior authorization to verify that the vitamins are råquired due to pregnancy. Viagra á , Cialis and Levitra á require priîr authorization for men under the age of 50. Á Lipid-lowering medications othår than Zocor (TMOP only) . Due to a national pharmāceutical contract for statins, Zocor á (simvastatin) is the prefårred Áhigh-potencyÁ statin in TMOP. TMOP will not dispense the fîllowing medications P rovider education for our South Rågion TRICARE providers is very important. Marketing and eduņation materials are abundant and include: Á Monthly/quarterly bullåtins and newsletters Á Annually updated provider hāndbook Á Job aides/charts/brochures Á Remittance messaging Á Autofax memîs Formal documents, such as the newsletters, bulletins and the prîvider handbook, are also available at www

