It seems as if every time you turn around there’s talk of Tricare changes. It isn’t just talk any more. As of October 1, 2015, there is a big policy change by the Defense Department. It issued a major change to how beneficiaries receive long-term medication that is brand name.
Tricare will no longer allow these maintenance medications to be filled at retail pharmacies.
All reoccurring medications must now be either ordered through the Tricare mail order pharmacy system, Express Scripts, or picked up at a military treatment facility (MTF).
Why is Tricare changing their policy on maintenance medication refills at retail pharmacies?
The reason why is abundantly clear, to save money. The government is always looking for ways to save money and this is yet another avenue they are choosing to go down. 61 million prescriptions, last year alone, were filled at retail pharmacies using Tricare. That cost the government $5.1 billion.
Using military treatment facilities or Express Scripts will save the government 32% on brand-name maintenance medications over retail store purchases. Government officials estimate moving to this new policy will save $88 million annually.
It isn’t just the Department of Defense that will save money. Beneficiaries are forecasted to save around $176 per prescription over the course of a year by no longer paying co-pays at retail pharmacies and instead having them filled at an MTF or through Express Scripts.
What will happen if you don’t switch to Tricare mail order pharmacy and instead try to fill your brand name drug at a retail pharmacy? You will pay 100% of the cost.
For immediate needs, new prescriptions for brand-name long-term care medications can be filled at retail pharmacies, but only for a 30-day supply or less. If more than 30 days is needed, the beneficiary is required to get further medication from a MTF or through the Tricare mail order pharmacy.
What happens if you run out or there is an emergency and you can’t get to a military treatment facility?
Tricare will continue to grant case-by-case exceptions for beneficiaries to include personal hardships, emergency and other circumstances. Those requests will need to be made through Express Scripts.
What will happen if you don’t switch to Tricare mail order pharmacy and instead try to fill your brand name drug at a retail pharmacy? You will pay 100% of the cost.
Because it doesn’t cost the government nearly as much, beneficiaries can still fill generic drugs using Tricare at retail pharmacies. Medications that treat acute illnesses and prescriptions that are covered by other insurance can also continue to be filled at retail pharmacies.
What are maintenance drugs?
Maintenance drugs are medications taken on a regular basis for chronic, long-term conditions. These include drugs that control blood pressure, antidepressant medications and painkillers, for example.
Related: Military Families May Need to Pay for ER Visits in the Future
They do not include short-term prescriptions such as drugs prescribed for short term uses, such as antibiotics.
How can you be sure if you need to fill your prescription through Express Scripts?
The Defense Health Agency has a list of drugs it categorizes as maintenance medications. This list will be available to beneficiaries on the Tricare Pharmacy Program website and will be available through Tricare Pharmacy Program Service Center phone system. You can also review the list of brand name maintenance drugs here.
If you are unsure if your prescription should be switched over to Tricare mail order pharmacy system, call Express Scripts at 1-877-882-3335.
There are 3 drugs on the list I need, and they do not have generic versions. Fortunately I receive them from the military pharmacy or Express-Scripts. I also take 2 pain drugs that are not listed, and I don’t know if there are generic versions. For all of us, it takes years before name drugs finally have to allow generics. Some folks will have to find a way to get to a military pharmacy or Express-Scripts.
Does this apply to Retirees under Johns Hopkins USFHP? Thanks.
Does this apply to retirees under Johns Hopkins USFHP? Thanks!