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TRICARE Ending Coverage of Nexium

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Starting on June 28, 2017, TRICARE will no longer include the drug Nexium in the preferred, or formulary, drug list, and it will no longer be available in military hospitals and clinics.

TRICARE's  long-term discount contract with the drug manufacturer ran out on April 1 of this year. Because of that patients are currently being asked to switch to one of the following three preferred alternatives that have been shown to work equally well for most patients:

  • Omeprazole
  • Pantoprazole
  • Rabeprazole

Your doctor may determine that the preferred alternatives are not right for you and that Nexium is medically necessary. To be medically necessary means it is appropriate, reasonable, and adequate for your condition. In those cases, TRICARE will continue to cover the cost of Nexium, minus the $20 copay for a 90-day supply of home delivery and $24 copay for a 30-day supply via a retail outlet.

Your doctor must submit a prior authorization and a reason why it is medically necessary via the Express Scripts doctor line in order for you to fill your prescription.

For patients who continue to use Nexium with a prior authorization but WITHOUT a doctor’s medical necessity determination, the non-formulary copay cost will be $49 for a 90-day supply via home pharmacy delivery or $50 for a 30-day supply via a retail outlet.

For more information regarding brand, generic drugs and which drugs are on TRICARE’s formulary list please visit the TRICARE website

 

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