For over two decades, Express Scripts has proudly administered the TRICARE Pharmacy Program. The program serves our nation’s active-duty service members, military retirees and their families with their pharmacy needs. In total, 9.6 million TRICARE eligible beneficiaries receive services that Express Scripts administers, including pharmacy services, military pharmacy claims, home delivery, and more.
Beginning March 1, 2024, the Department of Defense (DoD) will expand TRICARE Home Delivery, which includes specialty pharmacy services for active-duty service members, military retirees, and their families through Accredo specialty pharmacy. With this change, beneficiaries receive enhanced specialty care and individualized clinical support to help manage their chronic and complex conditions. Accredo offers these expanded clinical services at no additional cost to beneficiaries beyond the TRICARE cost-share. In addition, some beneficiaries will benefit from lower mail order copays for eligible medications.
“Active-duty service members, retirees, and their families have earned the highest quality pharmacy care,” said Tom Jenkins, Vice President, Military and Veteran Account Management, Express Scripts. “To further serve our nation’s heroes and continue to deliver exceptional care, this partnership with Accredo, the Military Health System, the Defense Health Agency, and Express Scripts will support robust benefits and the specialty care that these beneficiaries deserve.”
What is Accredo?
Accredo is an industry-leading specialty pharmacy that supports patients living with complex, chronic, and rare health conditions. Accredo patients are surrounded by a team of pharmacists, nurses, social workers, and dieticians who specialize in their condition. These teams are organized into Therapeutic Resource Centers (TRCs) that bring a deep level of condition-specific expertise and enable patients to manage their care and treatment with specialty medications.
What are specialty medications?
Specialty medicines are those used to treat complex, chronic, and rare health conditions. Many times, these drugs require special handling and administration (i.e., they may need to be refrigerated or administered as an injection). While it is estimated that specialty medications are used by less than 2 percent of the population, they can be quite expensive and account for more than half of total pharmacy spending.
TRICARE, through the DOD Pharmacy and Therapeutics Committee process, defines what is considered a “specialty medication” and maintains the specialty drug list.
What services are included with this change?
Beneficiaries who take specialty medications will have access to expanded specialty pharmacy services including:
- 24/7 beneficiary access to pharmacists, nurses, and clinicians who are trained to provide personalized care to patients.
- Individualized support from Accredo’s dedicated staff who specialize in different health conditions, including:
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- Lower mail order copays and up to 90-day refills for certain specialty drugs when beneficiaries choose TRICARE Home Delivery.
- Access to social workers, patient care advocates, and dieticians who can provide holistic support to patients navigating specialty conditions.
- Help in identifying copay assistance programs from non-profit foundations, which are allowed by the DoD.
- Convenient new digital tools and apps that allow beneficiaries to customize their care when and how they need, including order tracking and online payments, selecting specific delivery dates, refills by text, and dose reminders.
How will this transition take place?
TRICARE beneficiaries who currently receive their specialty medications through TRICARE Home Delivery will benefit from these enhanced services with no action required on their part starting March 1, 2024 . These beneficiaries will NOT experience a copay increase due to this change. These changes will not impact beneficiaries’ choice to fill their specialty medications at in-network retail pharmacies or military pharmacies. However, in some cases, future DoD formulary decisions may require beneficiaries to fill medications through TRICARE Home Delivery or at a military pharmacy.
Beneficiaries affected by this change will receive tailored communications in January 2024 with information about the transition, as well as a toll-free number to reach transition specialists by phone 24/7.
“With this evolution, TRICARE beneficiaries taking specialty medications will have unparalleled pharmacist support and resources to manage their care and make the most of these often lifesaving treatments,” said Jenkins. “As specialty medications continue to get more complex and costly, additional education and tools to empower beneficiaries – like those included through Accredo - will help improve outcomes and ultimately lower costs for taxpayers and the health system as a whole.”
