Meds and formularies

[curiousforever]

I have tricare for insurance. 3/4 of my meds are not on the military pharmacy formulary. So this past year I spent over 800 dollars on meds. When if I used the military pharmacy I'd pay NOTHING.

Would it be bad to ask the doc to write the stuff on the formulary?

They don't have lidoderm patches - but they have lidocaine 5% ointment 35.44g and lidocaine 2% jelly.......which one would be equivelent?

They have the flexeril and the neurontin....and the phenergan.

The percocet 10/325...all they have is 5/325 but they have oxycodone 5mg IR tablets...so I'd have to take 4 every 6 hours....right??

Ultram - they have 50 mg tabs which is what I take.

I don't think they carry requip though.

Any suggestions?

[Kira]

I tell my doc that my pharmacy benefits have a formulary and let them know which plan it is. If I know ahead of time which particular med(s) I need, I will look up if they are listed or not so that I can tell the doc. My pharmacy benefits' formulary is on their website, so we can look it up while in the doctor's office if needed.

As long as you are asking for an equivalent med/dose, I don't see why there would be a problem.

With the opiates, I know it can be a "red flag" to ask for a particular med, though. In that case, I would just say that my insurance has a formulary and that we need to pick something on the list if possible... then show them the list and let them pick. That way, you aren't asking for a particular med, just for them to pick something that you will be able to afford.

If you ask for plain oxycodone instead of percocet, they might think you are asking so that you can get a "pure" opiate without the tylenol so that you can take more. Because of that, I would just ask it like you asked us... that you want to pick alternatives for your current meds that are on the formulary list, and then let the doc come up with which ones they want to substitute.

Is there somewhere you can get a printed list?

Also, it's possible that your doc will have already have access to the formulary list for Tricare, and then all you would have to do is ask them to pick something covered by Tricare and they could look it up. It is worth asking.

I definitely think, though, that if it is possible for you to switch to meds that are covered, then by all means you should try to do that. It is not uncommon at all for patients to ask for meds that are covered by their plans.

[Gymnast_Navy_Wife]

Curious---
I am not sure which version of tri care you are on, BUT, tri care will in some instances, pay for non formulary medications. I am on or have been on several non formulary meds that tri care ended up covering. What your doctor needs to do is write a letter of "medical neccessity" (although tri care still says the final yes or no and if it is a yes, you may have to use their mail order pharmacy with a small co-pay ) . If he/she is a military dr, they should be familiar with that, if not, you may need to go to the tri care website and print out the information about how letters of medical necessity, etc are done. Also, another thing to remember is how big the military pharmacy is--- the bigger the pharmacy the better chance there is of them carrying your meds. There are over 5 military pharmacies in my area and all their formularies are different--- and only the main hospital (an hour a way) carries most of my meds, so I have to travel there.

Good Luck !
GNW

[curiousforever]

We are wayyyyy out in the boondocks GNW. It's a 3 hour trip to San Diego - and I found out where we go (for son's arm) doesn't carry a few of them either.

Maybe just telling him I want them all to go thru the military pharmacy - yep - then letting him choose the alternatives. There are other meds that appear to be pain meds - but I don't know anything about them.

[Lea]

I am an old Air Force brat, but also have experience doing reviews with the Tricare system. Your doctor CAN request a waiver and get your nonformulary meds paid for.

My parents have Tricare for Life and they only pay $9 a med at the civilian pharmacy. You could also call the benefits line at Tricare and explain your situation and ask them what you need to do to get your meds covered.

[curiousforever]

Lea - they are covered so I pay the co-pay. But technically I shouldn't have to pay anything. It burns me that it's not my fault these particular meds work very well for me - yet I'm paying for something I don't think I should have to.

Last year alone I spent over 800 for meds. I know others pay a lot more - but if I could get my meds at the military pharmacy - they'd be free.