Starting October 1, 2015, a new law requires all TRICARE beneficiaries, except active duty service members, to get select brand name maintenance drugs through either TRICARE Pharmacy Home Delivery or from a military pharmacy. Beneficiaries who keep using a retail pharmacy for these drugs will have to pay the full cost.
Maintenance drugs are those you take regularly for a long time, such as drugs to control blood pressure or cholesterol. The law does not apply to drugs you take for a short time, like antibiotics, or generic drugs. Beneficiaries living overseas, or with other prescription drug coverage, are not affected.
The TRICARE pharmacy contractor, Express Scripts, is sending a letter to beneficiaries taking an affected drug, explaining their options. Beneficiaries can contact Express Scripts at 877-363-1303 to see if they are affected.
After October 1, beneficiaries still filling an affected drug at a retail pharmacy will receive another letter informing them of the change to the benefit. After that, beneficiaries have one final “courtesy” fill at a retail pharmacy. If they fill at a retail pharmacy again, they have to pay 100 percent of the cost of their medication.
How will this new TRICARE pharmacy change affect me?
This change doesn't apply to all drugs—it only applies to select maintenance drugs. If you have a short term prescription, such as an antibiotic or pain medication, you can likely still use a network pharmacy.
Active Duty Service Members
This change won't affect you.
Beneficiaries Using TRICARE For Life
Because you're already required to use the TRICARE For Life Pharmacy Pilot, this change won't affect you. Basically, how you refill prescriptions is now becoming the process for everyone else.
Beneficiaries Outside the U.S.
This change only affects select maintenance drugs in the U.S. and U.S. Territories. There's no change for prescriptions filled in all other overseas areas.
All Other Beneficiaries
Right now, you can refill most of your prescriptions at any of TRICARE's pharmacy options. Beginning October 1, you will be required to refill select maintenance drugs through home delivery or at a military pharmacy.
If You Have Other Health Insurance
This change may not apply to you because you can't use home delivery when you have other health insurance, unless:
- Your other plan doesn't include pharmacy benefits,
- Your other plan doesn't cover the drug you need, or
- You've met your other plan's benefit cap.
How will I know if I have to switch?
If you are currently taking a drug affected by this change, you'll get a letter from Express Scripts. This letter will explain what you need to do about a month before the program starts. To get this letter, make sure your address is correct in the Defense Enrollment Eligibility Reporting System (DEERS).
Are your drugs affected?
You can see if you'll have to switch by:
- Calling Express Scripts Member Choice Center at 1-877-363-1303, or
- Viewing the TRICARE list of select maintenance drugs
When do I need to switch?
If you get a prescription for a select maintenance drug after the program begins:
- You can fill it up to twice at a network pharmacy.
- After that, you need to switch it to home delivery or a military pharmacy.
- If you continue to fill your prescription at a network pharmacy, you'll pay the full cost.
To switch now, call the Express Scripts Member Choice Center at 877-882-3335.
How do I switch to a Military Pharmacy?
- Military pharmacies don't stock all drugs on the TRICARE formulary, so it may not be available.
- Call your military pharmacy to see if your drug is on the formulary and request to transfer your prescription.
How do I switch to Home Delivery?
For more information about the TRICARE Pharmacy program including how to sign up for mail delivery, and how to file claims visit the TRICARE Pharmacy Program website.
Do I have any other options?
Use Generic Drugs
If you're using a brand name drug with a generic substitute, use the generic instead. You can continue to refill prescriptions for generic drugs at a network pharmacy.
You May Qualify for a Waiver
In some limited scenarios, you may qualify for a waiver.
- Emergency
- Personal needs
- Special circumstances, such as living in a nursing home
You may also get a waiver if the drugs are back-ordered by the mail-order pharmacy.
