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Tricare stops covering non-FDA approved compound rx's

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  • Tricare stops covering non-FDA approved compound rx's

    http://www.marinecorpstimes.com/arti...cription-drugs

    This includes heparin instills and a lot of the suppositories we use. I got the letter. Anyone else?
    For a cure...
    Take: Elmiron, baclofen, sanctura, instills, biotin, and uribel.

  • #2
    Re: Tricare stops covering non-FDA approved compound rx's

    Hi - what has been the latest to this change? Were you able to find a work around? I just switched back to standard, so I'm already expecting my costs to go up. Just not sure what to expect as far as RX costs go though. I made the switch to standard to get a decent idea about what the heck I have been dealing with...

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    • #3
      Re: Tricare stops covering non-FDA approved compound rx's

      I don't know about this specific coverage, but I do know that it's not unusual for insurance companies to deny coverage in a lot of instances. It's actually so common that my pain specialist office has a form to apply for exceptions. So far, all of the denied was approved when appealed by my doctor's office. This has happened on three different occasions --- one for a bone treatment for cancer patients, one pain patch, and an anti-nausea medication. They deny things to save money and since a lot of people don't argue with them, they get away with it.


      Donna
      Stay safe


      Elmiron Eye Disease Information Center - https://www.ic-network.com/elmiron-p...mation-center/
      Elmiron Eye Disease Fact Sheet (Downloadable) - https://www.ic-network.com/wp-conten...nFactSheet.pdf

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      Click on ICN Shop at the top of this page. You'll find Bladder Builder and Bladder Rest, both of which we are finding have excellent results.

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      AUA Guidelines: https://www.ic-network.com/aua-guide...tial-cystitis/

      I am not a medical authority nor do I offer medical advice. In all cases, I strongly encourage you to discuss your medical treatment with your personal medical care provider. Only they can, and should, give medical recommendations to you.
      [3MG]

      Anyone who says something is foolproof hasn't met a determined fool

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      • #4
        Re: Tricare stops covering non-FDA approved compound rx's

        Originally posted by Running View Post
        Hi - what has been the latest to this change? Were you able to find a work around? I just switched back to standard, so I'm already expecting my costs to go up. Just not sure what to expect as far as RX costs go though. I made the switch to standard to get a decent idea about what the heck I have been dealing with...
        Well, I would suggest downloading(you can get it for free off the internet) or the booklet they gave you(hopefully gave you, when you switched if you did it in person). You can also call Tricare Customer Service to find out specific info. The deductible is 250 I believe or 200. And then you pay 15-20%(can't recall but pretty sure it is 15) until you meet you catastrophic cap, which is 1,000 or 2,000 dollars paid out-of-pocket. Then they pay everything at 100% for the rest of the fiscal year(which is Oct for the military).

        No, they will still not cover the instills with Heaprin b/c they're not FDA approved. So, there is no getting around that one. But as far as other bladder medications, I haven't had much trouble with the main ones. Only ones like Lyrica(they want you to do certain ones first) and your doctor has to send approvals for certain medications if they try to fight it, that explains why you need that versus another medication. Like an allergic reaction or something like that. Otherwise, it really hasn't been an issue for me other than the instills, which thankfully I did not need anymore at the time they cancelled them.

        I hope this answers some of your questions. It would actually be harder under Prime to get any of these meds, let alone find a doctor who would understand this. Or be referred to a decent one. So, I think you made the right call switching to Standard IMHO. And so it does cost a bit until you get that deductible met but the 15-20 percent usually doesn't end up being much and with this disease and other sickness, that catastrophic cap gets met pretty quickly. There is much less red tape, paperwork and much more choices you have. And well worth it in my opinion. I've been on standard for years now and don't regret it at all.

        Best of luck to you and I think you'll feel the same once you get used to all the ins and outs of it.
        For a cure...
        Take: Elmiron, baclofen, sanctura, instills, biotin, and uribel.

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        • #5
          Re: Tricare stops covering non-FDA approved compound rx's

          Do RX cost shares factor into the cast cap on Tricare? I am thinking those are different. I am already planning to set aside the $1500 for the cap, it's the medication costs I'm more nervous about. That said, I do expect them to be the same as with prime just wasn't sure about a max.

          Thank you for the reassurance about the ease! I've been in pain and discomfort since August and dealing with prime and the naval hospitals has yielded NO answers. I switched on Wed, called a local gyno office that day (assuming it was my lady parts) and at my appointment on Friday she said she was thinking more along the lines of IC. First doctor in four months who has even come close to matching my issues with a dx! Feeling so much more hopeful now!

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          • #6
            Re: Tricare stops covering non-FDA approved compound rx's

            Appeal, appeal, appeal and if that fails they need to provide you with a suitable alternative. Warmest regards, and best of luck!
            Love is a fruit in season at all times, within reach of every hand. ~ The Blessed Mother Teresa

            Status: Diagnosed October 2006 via cystoscopy with hydrodistention. Max anesthetized bladder capacity only 250 cc's. Mast cells and pinpoint bleeding found.

            Remission for me means less pain for more days than not. Frequency is inevitable with a bladder this tiny! That is ok though. The difference between when I was diagnosed and now, is that I have embraced that fact. Me and the loo, we are one.

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            • #7
              Re: Tricare stops covering non-FDA approved compound rx's

              I have Tricare Prime and they have covered all my bladder instills with heparin, Kenalog, and lidocaine. I have not had any issues with the other meds either (vaginal Valium and so on). I am not sure if it hasn't caught up with me or it the policy has changed.
              Should I be worried?

              Thanks for this interesting thread.

              d

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