A new TRICARE policy begins on October 1, 2015 that will affect how many TRICARE members receive certain prescription drug refills. Non-active duty TRICARE members will be required to receive refills of select name-brand maintenance medications from a Military Treatment Facility (MTF) or through the TRICARE Pharmacy Home Delivery, otherwise they will be required to pay full cost at a retail pharmacy.
This change is part of the FY15 Defense Bill and is designed to save the military and TRICARE beneficiaries millions of dollars in the coming years. This does not apply to current active duty members, members living overseas, or members who reside in a nursing home. However, it does apply to dependents of active duty members living in the US, and it applies to retirees and their dependents. Waivers are available on a case by case basis.
This is an extension of an earlier TRICARE for Life Pharmacy Pilot Program that had similar rules and begain in 2014.
This Change Applies to Maintenance Medication Refills Only
This change does not apply to the initial prescription order, nor does it apply to medications used to treat acute illnesses. This change is only intended for refills of maintenance medications.
Maintenance medications are used to control chronic illnesses such as high blood pressure, high cholesterol, diabetes, and similar chronic conditions. Medications prescribed for acute conditions, such as antibiotics, pain killers, etc. are unaffected by this pilot program. Here is a list of maintenance medications from the TRICARE for Life pilot program.
Cost Savings for Mail Order Prescriptions
This change will likely cause a little inconvenience while going through the learning curve, but there is a silver lining. Prescriptions filled at Military Treatment Facilities don’t have any associated costs, and the copay through the TRICARE Pharmacy Home Delivery is significantly less expensive than purchasing prescriptions through a retail pharmacy. Here is a chart from the Express Scripts website showing the cost of prescriptions delivered through the TRICARE Pharmacy Home Delivery compared to those purchased at a retail pharmacy.
Image Source: – Express Scripts.
How to Change Your Prescriptions to Mail Order
Affected TRICARE beneficiaries should receive a letter from TRICARE in mid-September outlining the process change, and which steps are required to change your prescriptions to home delivery. There will also be a small grace period to move all your prescriptions over to home delivery before TRICARE will charge members full price for fulfilling their maintenance prescriptions at a retail pharmacy.
Move your prescriptions to TRICARE Pharmacy Home Delivery:
- Online: You can order refills quickly and easily using your online account. Payment by debit or credit card is required at the time of purchase unless you are an active duty member.
- Mail: Fill out the Mail Order Registration Form (PDF) and then mail the form and your 90-day prescription to the address listed on the form.
- Phone: Call 877.363.1296 and have your prescription bottle handy. A patient care advocate will work with your doctor to transfer your maintenance medications to Home Delivery.
It is recommended to have a 30-day supply of medication on hand while your first order is processed to prevent gaps in your medication.