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: Prior Authorization
Your doctor can request prior 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 prior authorization:
- Download or contact Express Scripts to get a Compound Drug Prior Authorization 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.
Last Updated 6/18/2020