Compound Drugs

Compound drugs are:

• A combination of two or more drugs
• Prepared by a pharmacist
• For a patient’s individual needs

Screening Process for Compound Drugs

Step 1: Electronic Screen

Express Scripts screens each ingredient to make sure:

• TRICARE covers it.
• It’s safe and effective.
• It's medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition..

This step usually takes less than 5 seconds to complete.

Step 2: Required if the Compound Doesn’t Pass Step 1

If the compound drug—or any ingredient in it—doesn’t pass the first step, your pharmacist can:

• Remove the non-covered ingredient or replace it with a covered ingredient.
• Contact your doctor to request a different drug to treat your condition.

This step happens while you wait at the pharmacy. It may take 15–20 minutes.

Step 3: Pre-Authorization

Your doctor can request pre-authorization for the compound drug if they can’t substitute an ingredient or prescribe a different drug for you. This allows Express Scripts to individually review your prescription to make sure it’s safe, effective, and medically necessary.

To request pre-authorization:

• Download a Compound Drug Pre-Authorization Form or contact Express Scripts to get the form. 
• Give it to your doctor to complete and submit to Express Scripts. (Instructions are on the form.)

This step usually takes about 5 days from when Express Scripts gets all the necessary paperwork.

If your compound drug doesn’t get approved, you have 90 days to request a formal appeal.