Health & Safety

May 8, 2017
 

TRICARE changes to Nexium coverage

Starting June 28, 2017, the drug Nexium will no longer be a TRICARE preferred, or formulary, drug.

This means it will no longer be available in military pharmacies, and you will pay more if you get it through TRICARE Pharmacy Home Delivery or a retail network pharmacy.

Nexium is a brand name prescription drug often prescribed to treat gastroesophageal reflux disease. To prepare for the change, patients can switch to one of three preferred drugs for the treatment of GERD.
• Omeprazole
• Pantoprazole
• Rabeprazole

Your doctor may determine that the preferred drugs are not right for you and Nexium is medically necessary. In that case, TRICARE will cover the cost of Nexium. The normal copays for brand name formulary drugs through home delivery and retail network pharmacies will apply.

To get medical necessity, your doctor must submit a prior authorization request to Express Scripts that includes a reason why Nexium is deemed medically necessary for you. If you already have a prior authorization for Nexium, your doctor must submit an additional medical necessity determination, or you will have to pay the non-formulary copay.

What is GERD and how is it treated?

GERD is a chronic digestive condition, which occurs when stomach acid flows back into the esophagus. This acid irritates the lining of the esophagus, which over time can lead to GERD.

Many people can make lifestyle changes and take over-the-counter drugs to manage their GERD symptoms. Sometimes, people need prescription drugs to reduce their symptoms.

The National Institutes of Health has more information about GERD and drug choices to treat it. For more information regarding brand and generic drugs, and which drugs are on TRICARE’s formulary, please visit https://tricare.mil/CoveredServices/Pharmacy?sc_database=web.




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