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Changes to TRICARE pharmacy benefit

  • Published
  • By Maj. Michele Serrano
  • 90th Medical Support Squadron
A new law that went into effect Oct. 1, 2015, requires most TRICARE beneficiaries to get brand-name maintenance drugs from TRICARE Pharmacy Home Delivery or a military pharmacy.  If beneficiaries keep using a retail pharmacy for these drugs, they will have to pay the full cost.

Active-duty service members are exempt from the law's requirement.

Maintenance drugs are those taken regularly for a long time, such as drugs to control blood pressure or cholesterol.  The law does not apply to generic drugs or to short term medications, such as antibiotics.

The law also does not apply to beneficiaries living overseas or who have another insurance plan with prescription drug coverage.

"A military pharmacy is a great way to fill maintenance drugs, since you can get up to a 90-day supply, and there's no cost for TRICARE beneficiaries," said Col. Hans Ritschard, 90th Medical Group commander.

To see if a prescription is available, contact the F. E. Warren Air Force Base pharmacy at 773-3461.

TRICARE Pharmacy Home Delivery is another low cost option to get maintenance drugs.  Beneficiaries can get up to a 90-day supply, as opposed to a 30-day supply from a retail pharmacy, and offers a $176 savings per year on co-payments for every brand name drug switched to home delivery.

Beneficiaries affected by the change should have received letters from Express Scripts, Inc., the TRICARE pharmacy contractor.  These letters informed beneficiaries of their options if they were taking an affected drug.  Beneficiaries can also call Express Scripts at 1-877-363-1303 to see if they are affected.

After Oct. 1, Express Scripts will send another letter to beneficiaries who continue using a retail pharmacy for affected drugs.  After that, beneficiaries will have one more chance to fill these prescriptions at a retail pharmacy before they have to pay 100 percent of the cost of their medication.

For more information about this change to TRICARE's pharmacy benefit, please visit www.tricare.mil/RxNewRules.