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Tricare drops Nexium from preferred drug list

May 2, 2017
About 338,000 Tricare patients who have a Nexium prescription are being asked to switch to an alternative drug for their stomach and esophagus problems.

As of June 28, Nexium will no longer be included on the Tricare preferred, or formulary, drug list, and it won’t be available in military hospitals and clinics. 

Defense health officials estimate that the change will save about $1.6 million a day in health care spending, said Kevin Dwyer, spokesman for the Defense Health Agency. That adds up to about $584 million a year.

“Tricare is constantly working to provide its patients with the highest quality of care at the best possible cost to both them and the government,” Dwyer said. “For this reason, when the Department of Defense’s 10-year-old preferred pricing agreement with AstraZeneca ended on April 1, Tricare began phasing Nexium out and recommending three less-expensive medications that work equally well for most patients.”

Those three drugs are Omeprazole, Pantroprazole and Rabeprazole. 

Dwyer noted that officials expect about 10 percent of patients to have a medical reason to continue using Nexium, determined by their doctor to be medically necessary. These patients will still be able to receive the medication at the brand name co-payment: $20 for a 90-day supply of home delivery, $24 for a 30-day supply at a retail outlet.

For patients to receive Nexium at those prices, a doctor must submit a prior authorization -- and a reason why the drug is medically necessary -- through the Express Scripts doctor line, Tricare officials said. 

Patients who continue to use Nexium with prior authorization but without a doctor’s medical-necessity determination will pay the nonformulary co-pay cost of $49 for a 90-day supply through the mail, or $50 for a 30-day supply at a retail outlet.  

Nexium is a popular drug used to treat gastroesophageal reflux disease (GERD), a chronic digestive disease. It occurs when the stomach acid flows back into the esophagus and irritates the lining. 

Karen Jowers writes about military families, quality of life and consumer issues for Military Times. She can be reached at kjowers@militarytimes.com.

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