Tricare and Trimix

[flyingduck2019]

NOTICE TO VETERANS: There has been a change to the formulary when it comes to Trimix. In the past, I have ordered my trimix from a compounding pharmacy twice and got it with no problems and Tricare paid.
I ordered a new batch last week and it was refused by tricare because two of the ingredients are no longer on their list of medications they will cover.
So, I have to see if I can switch from Trimix to bimix or quadmix. I will see my URO tuesday and will discuss the situation with her.

[bldoink]

Which 2 ingredients are off the list? You might be down to mono-mix, as in alprostadil (PGE-1).

[flyingduck2019]

I hope I have these spelled right. They are not any of the 3 main juices.
Here they are: Sodium Metabisulsite powder and Bacteaiost water.

Beats the hell out of me.

[bldoink]

Wow, that's strange. Those aren't even drugs. The one is the sterile water with ingredients to prevent bacteria growth and the other is a preservative. I can't imagine why it would get rejected for those ingredients.

[flyingduck2019]

It's a mystery to me as well. I guess it all depends on who you talk to at the time rather than having a guide written in stone.

I will see my URO tuesday to get my testostrone injection and we will discuss the matter. I am told by Tricare that my URO can call a certain phone number at Tricare and request an "override approval" and if approved, Tricare will pay for the trimix. Given the benefits of the juice, going through the hassled every 6 to 8 months is worth the savings I get in cost.

The other option would be to find another juice that will work. I would prefer the quadmix and just drop my dose. I started at 20 units so if the quadmix is the strongest I could probably drop the dose to 5-10 units and get the same results. I will just have to talk to my URO and see what she advises. At age 73, if push comes to shove I will see if I can go with a implant.

[bldoink]

Well Edex and it's competitor appear to be on your approved list and at a good price, if you tolerate alprostadil well.

[flyingduck2019]

Thanks for the information. I just filed a appeals form with the insurance and explaining they had already approved two orders for the same juice, so why are they denying my last order? I also explained that the two ingredients they denied are most probably part of bi, tri and quadmix. I mean, how much of the water and powder could be in a 10ml order? Surely, the two can't be that expensive, maybe $2 at most?

I will post when i get a response from the insurance.

[flyingduck2019]

OK guys, after working very hard with my compounding pharmacy in Los Angeles and making a bunch of phone calls to Tricare, Tricare for Life and Express Scripts it appears that some of the customer service people at each of these three places can't tell their ass from a hole in the ground! They lack the training and knowledge required to give accurate information to customers.

Let's go back to square one: Over the past two years I have had my compounding pharmacy fill three orders for my Trimix. I finally found out that the claims go to Express Scripts which is the military pharmacy contracted by Tricare. Express Scripts does not compound medications, hence the compounding pharmacy of your choice compounds and files a claim with Express Scripts in order to get paid.
My first two orders went like clockwork. No issues. This last order took almost 3 weeks to complete because people at the 3 places named kept telling me and my pharmacy that my pharmacy was no longer on the approved list to submit claims OR two of the ingredients required in the compound was not on the list of approved items they covered. We (my pharmacy and I) went round and round with these fools.

Finally, my pharmacy got in touch with the right knowledgeable person at Express Scripts. This person told the pharmacy exactly what to do and how to do it. The pharmacy submitted the claim and it was approved and paid within 4 hours.

So, if you are a veteran and are using Express Scripts don't let them give you or your pharmacy a line of bull shit! Keep on them until they get it right. Keep going up the food chain if you have to. I talked to two supervisors and both gave me a line of BS.

If I can be of help to anyone just PM me and I will help you if I can.

[KenJ1947]

OK guys, after working very hard with my compounding pharmacy in Los Angeles and making a bunch of phone calls to Tricare, Tricare for Life and Express Scripts it appears that some of the customer service people at each of these three places can't tell their ass from a hole in the ground! They lack the training and knowledge required to give accurate information to customers.
...

Finally, my pharmacy got in touch with the right knowledgeable person at Express Scripts. This person told the pharmacy exactly what to do and how to do it. The pharmacy submitted the claim and it was approved and paid within 4 hours.

So, if you are a veteran and are using Express Scripts don't let them give you or your pharmacy a line of bull shit! Keep on them until they get it right. Keep going up the food chain if you have to. I talked to two supervisors and both gave me a line of BS.

If I can be of help to anyone just PM me and I will help you if I can.

I'm hoping I won't need your help but, if I do, I'll be contacting you. Thanks for the info.

[flyingduck2019]

Ken--If you can go this route you will save a ton of money. I get 10ml's of my trimix per order. I pay $33.00 plus a $10.00 overnight delivery charge. If I payed out of pocket it would cost me $221.00.

Please let me know how you make out with your journey.

Phil