Prior Authorization Allows Custom Care Published Oct. 5, 2015 By TRICARE.mil Staff Communications Division, Defense Health Agency FALLS CHURCH, Va. -- Healthcare is rarely one size fits all. The TRICARE benefit is designed to ensure that all covered care is safe, effective and appropriate for the patient. Sometimes this means that certain types of specialty care and prescription drugs require special review to make sure they are right for the patient. Prior authorization lets your doctor provide additional information so TRICARE and our contract partners can make an individual review of your care. Prior authorization is a standard process throughout the health industry, including other government health plans like Medicare. If a procedure or drug requires prior authorization, it may be because there is an equally effective treatment or therapy available at a lower cost. This lowers the cost of care for everyone, and protects the TRICARE benefit for future generations of the military community. Prior authorization applies to more than 80 drugs under the pharmacy benefit, and some compound drugs. A common reason a drug needs prior authorization is if it is a brand name drug with a generic equivalent. In these cases, TRICARE requires you to use the generic version of the drug, but prior authorization lets your doctor provide evidence to show that the brand name works better for you. Another example is some compound drugs that have commercially available versions. Compound drugs are a combination of two or more drug ingredients made specifically by your pharmacist to meet your individual needs. Prior authorization allows your doctor to submit additional evidence that the ingredients in your compound drug are safe and effective, and to show that commercially available drugs aren't appropriate for you. You can find the form to submit a compound drug prior authorization, and get more information on TRICARE’s compound coverage on the TRICARE website. You work with your doctor to get prior authorization, which is typically good for one year. You can check the status of your request for prior authorization on your regional contractor’s, or Express Scripts’ website. Regional contractor websites can be found on the View My Referrals/Authorizations page on the TRICARE website.