Changes coming to TRICARE pharmacy benefit Oct. 1

  • Published
  • By 28th Medical Group
ELLSWORTH AIR FORCE BASE, S.D. --  
Beginning Oct. 1, a new law will require all TRICARE beneficiaries, except active duty service members, to obtain select brand name maintenance drugs through either TRICARE Pharmacy Home Delivery or from a military pharmacy. Beneficiaries who continue to use a retail pharmacy for these drugs will have to pay the full cost.

Maintenance drugs are those an individual must take regularly for a long time, such as drugs to control blood pressure or cholesterol. The law will not apply to drugs taken for a short time, like antibiotics or generic drugs.

The TRICARE pharmacy contractor, Express Scripts, will notify affected beneficiaries, by mail to explain the new requirement and available options.

Those affected should expect to receive a letter from Express Scripts in September alerting them to switch medication sources. After October 1, anyone still filling prescriptions of affected drugs at a retail pharmacy will receive another letter reminding them of the change to the benefit. 

After the reminder, people choosing to use a retail pharmacy will be given one final courtesy prescription prior to the 100 percent cost implementation.

One option available to impacted beneficiaries is TRICARE's home delivery, which is a safe, convenient and low cost option to order maintenance drugs, providing up to a 90-day supply, as opposed to a  30-day supply from a retail pharmacy. Beneficiaries can also save up to $176 each year per brand-name drug if they use the home delivery service.

Another option is using a military pharmacy, which offers up to a 90-day supply of drugs at zero co-pay, but  all drugs may not be are available. Beneficiaries should check with the 28th Medical Group Pharmacy to see if they carry certain prescriptions.

Individuals living overseas, or with other prescription drug coverage, will not be affected.

For more information about this change to TRICARE's pharmacy benefit, contact Express Scripts at 1-877-363-1303 or visit www.tricare.mil/RxNewRules.