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tricare and Trimix

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Posted 2/21/2012 10:13 PM (GMT 0)
Does tricare prime (retiree) cover trimix?
Posted 2/22/2012 6:44 AM (GMT 0)
Got my first scrip filled at a compounding pharmacy, filed the paperwork manually, it was rejected...Stated this drug not covered. I seem to recall another poster was getting trimix and it was covered. I did get a scrip for levetra that was covered. I guess they think trimix is a recreational drug, although it is really for rehabilitation.
Good luck,
Posted 2/22/2012 9:01 AM (GMT 0)
Just give em a call and ask if its covered. Did they cover any other ED meds?
Posted 2/22/2012 2:53 PM (GMT 0)
ok here is the news! Tricare covered the Trimix, for a $12 co-pay. the syringes at our compounding pharmacy is $15 for 50. And the Androgel is going to be $12 co-pay.
Posted 2/22/2012 3:17 PM (GMT 0)
Hey Susan,

Did Tricare provide the Trimix through the mail in pharmacy or did they reimburse you?

Posted 2/22/2012 3:30 PM (GMT 0)
I took the prescription to a local compounding pharmacy and she ran it through tricare, they took care of it, so all I have to do is drive to the pharmacy and pay the $12 co-pay and pick it up. Express scripts can't fill Trimix due to needing to be mixed, at least this is my understanding. The URO told us we HAD to get it filled at a compounding pharmacy, so I didn't even bother with express scripts.

I did have to find a compounding pharmacy who filled insurance. The first one I went to only deals with payment upfront and then I would have had to file a claim to get reimbursed. So I asked them if they knew one in town who filed and they referred me to the one I ended up with.

Hope this helps
Posted 2/22/2012 5:21 PM (GMT 0)
Trimix is made on the spot by the compounding pharmacist to match the doseages prescribed. It has to be refrigerated.

At my pharmacy, they require at least 24 hour notice, but are much happier if you give them a couple of days lead time.

Susan - take an insulated/cold bag or small cooler with you to pick it up. I have an old insulated lunch bag, and some quick-freeze packs for this task. You wouldn't want to have it get hot if you were stuck in traffic or got off to another errand.

I have seen mention of some mail-order compounding pharmacies that ship in dry ice. My insurance company uses a (huge national) mail-order company for 90 day prescriptions, but they do not do compounding work.

Posted 2/22/2012 5:24 PM (GMT 0)
Thats a brilliant idea (the cooler) and one I would not have thought of. Thanks!!!
Posted 3/15/2012 5:52 PM (GMT 0)

Susan R said...
I took the prescription to a local compounding pharmacy and she ran it through tricare, they took care of it, so all I have to do is drive to the pharmacy and pay the $12 co-pay and pick it up. Express scripts can't fill Trimix due to needing to be mixed, at least this is my understanding. The URO told us we HAD to get it filled at a compounding pharmacy, so I didn't even bother with express scripts.

I did have to find a compounding pharmacy who filled insurance. The first one I went to only deals with payment upfront and then I would have had to file a claim to get reimbursed. So I asked them if they knew one in town who filed and they referred me to the one I ended up with.

Hope this helps

 

I am retired military and have been trying to get Trimix covered but always rejected by Tricare Express scripts.  Latest attempt today March 15, 2012.  For Susan R.  Can you provide more info as to the Pharmacy, location etc. where you got it approved.  I would like to call them (phone number) and try to find out how they got it approved.  Please reply to my e-mail at: (see email in member profile - open email removed for security - 142).  Thank You.

Post Edited By Moderator (142) : 3/15/2012 12:36:57 PM (GMT-6)

Posted 3/15/2012 7:10 PM (GMT 0)
raycasa,

I'm not on TriCare, but I had the same issue with my (big, national, mail order) insurance, and family members see the same types of issues with TriCare - they have to choose pharmacies that know the system.

You will need to look for a local compounding pharmacy and go directly to them. They seem to be few and far between, but others have mentioned some on the east coast that ship. A search would be in order.

There is a compounding pharmacy that I was aware of from other medical needs. My uro called the prescription to them. It took them a week of haggling with the insurance company, but they eventually got it covered. As I understood it, the pharmacist had to explain to them that it was not for ED as a separate issue, but that it was to treat ED as a side effect of my prostatectomy. It seems simple enough, but the codes and process were very different. There were dozens of phone calls, and several escalations along the way.

I edited your post, since your email is in your profile. Hopefully that will keep the spammers away for one more day.

Posted 3/15/2012 7:16 PM (GMT 0)
That's (good) news to me. As of last December I was told that tricare would not cover trimix.
Posted 3/15/2012 7:25 PM (GMT 0)
Forum Moderator 142,

Thanks for the quick reply. What you explain makes some sense, but getting a uro and pharmicist to make that call is difficult at best. The indication from the Susan R thread comments, that it happened with no intervention needed. Thats why I wanted to know where this pharmacy was. Any further comments you can provide is appreciated.

raycasa
Posted 3/15/2012 10:37 PM (GMT 0)
Tri care covers My levitra but They said it only covers for 6 pills a month...what a crock.
Posted 3/16/2012 12:42 AM (GMT 0)
Raycasa- I wrote your email addy! Check your email

Casper.....you can get your DR to call the pre-autorization phone number for Tricare and get 30 pills per month, or 90 for a 3 month rx from mail order express scripts. We get 90 pills for 90 days of Levitra via express scripts. Don't settle for the "we will only cover 6 per month" That is crap and NOT true. Email me if you need more info - email is listed on my profile
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