Compounded Drugs

As of May 1, 2015, TRICARE changed coverage rules for compounded drugs. Compound drugs are:

A combination of two or more drugs, prepared by a pharmacist for a patient’s individual needs.

The new rules will require that each ingredient in the compound:

  • Is covered by TRICARE
  • Is safe and effective
  • Doesn’t exceed the cost standard
  • Is being filled by a network pharmacy
    • Note - not all network pharmacies compound drugs                            

Many compounded drugs that have been covered in the past will no longer be covered.

Example of compounded drugs that could be covered:

If the compound drug—or any ingredient in it—doesn’t meet the coverage requirements above, you can ask your doctor about:

  • Hormones creams
  • Pain creams
  • Basically any compound that contains a non-TRICARE covered active or inactive cream ingredient (including bulk compounding powders and inactive bulk powders or bases)
  • A covered drug that comes in tablet form but not liquid form and the patient cannot swallow tablets.If the pharmacist takes the covered tablet and compounds it into a liquid form this would be covered
  • Keep in mind this is extremely rare as most medications now either come in liquid form or can be crushed or chewed
    • Note - coverage would not be granted if a liquid or chewable form is already covered by TRICARE as a non-compound

If the compound drug or any ingredient in it doesn't meet the above coverage requirements, you may ask your doctor about:

  • Prescribing a TRICARE covered medication instead of a compound
  • Remove or substitute the non-covered ingredient with a TRICARE covered ingredient
    • If neither of these options are possible, your doctor can fill out a prior authorization form, but this does not guarantee coverage.
  • If the prior authorization is approved you can get the compound
  • If prior authorization is not approved then coverage will not be granted
  • If you still want the compound you will need to pay out of pocket
    • Note - you can appeal this decision to USFHP within 90 days.

Want to learn more? Visit the Defense Health Agency's (DHA) web site.