On December 1, 2016, Tricare removed CVS, including CVS inside Target, from the Tricare retail pharmacy network and added Walgreens and Kroger.
That means that if you currently fill your prescription at CVS, you will need to move your prescription to another network pharmacy or pay full price for that medication.
You have options when it comes to filling a prescription. If you are one of the numerous beneficiaries that need to move your prescription, consider these options when switching.
Military Pharmacies
You can have your prescription filled at a military treatment facility. There is no change to military pharmacies at this time. Medication can to be filled at military treatment facilities free of charge. Call the closest one to you to see if they have the medication you need on hand.
Civilian Pharmacies
If you choose to fill prescriptions out in town, Tricare recommends Walmart, Rite Aid, Walgreens and Kroger as the largest pharmacies with the ability to obtain specialty medication. There are more than 58,000 retail pharmacies in network. This includes other national chains as well as pharmacies in grocery stores and independent pharmacies that you can fill your prescriptions at.
TRICARE Pharmacy Home Delivery
If you have maintenance medications, medicine that you take regularly, it is free to use the Tricare pharmacy home delivery system. You can order prescriptions online, over the phone or through the mail.
Even if you choose to have an initial prescription filled at a military treatment facility, you can still have the refills sent through Tricare home delivery.
A patient care advocate will contact your doctor if you need help getting your prescription transferred. Through Tricare pharmacy home delivery, you will receive a 90-day supply of your medication. Tricare recommends that you have 30 days of medicine before ordering to ensure there is plenty of time to get you properly put into the system and that the medication arrives before you run out.
Ordering your medication through Tricare pharmacy home delivery has many benefits including: automatic refills, free delivery, free generics and the option to talk to a pharmacist at any time.
Saving money is another benefit. As of February 2016, generic medications carry a $30 retail network co-payment, while home delivery does not have one at all. Formulary brand medications filled at retail network pharmacies have a $72 copay as opposed to $20 through Tricare home delivery. Non-formulary medications could cost you $150 at a retail network pharmacy, but would only be $49 through home delivery. These prices reflect a 3-month supply of medication.
Getting Reimbursed When Using Non-Network Pharmacies
If you choose to fill your prescription at a non-network pharmacy, you will be required to pay the entire price of the medication up-front. You then file a claim to get a reimbursement. The amount you get back however depends on your status and Tricare plan.
Active duty service members will receive complete reimbursement.
Dependents on Tricare Prime will get 50% of the cost share back.
Those on any other Tricare plans can expect to pay $24 or 20% of the cost, whichever one is higher, for formulary drugs. This is only after you have met your annual deductible.
If you are filling a non-formulary prescription, you will pay $50 or 20% of the cost, whichever is higher, after meeting your annual deductible.
Claims must be filed within one year of filling the prescription at a non-network pharmacy. Through Tricare’s website, you can access the Patient’s Request for Medial Payment (DD Form 2642), which you will need to fill out and mail in.
How to Transfer Your Prescription
Transferring your prescription is easy. You simply take your prescription bottles to a new pharmacy and have them call your previous pharmacy or you can call a new pharmacy and ask them to contact your old pharmacy.
Another option is to contact your doctor and ask them to send a prescription to your new pharmacy. You can also call Tricare home delivery (855-778-1417) to see if they carry your medication and then have it delivered to you.
Final Key Points to Know
There are no other changes to the Tricare Retail Network. If you do not currently fill your prescriptions at CVS, including CVS inside Target, then you do not need to change anything with your prescriptions. There is no change to Tricare copays.
There is no grace period. If you fill a prescription at CVS after December 1, 2016, you will pay for the entire medication and then need to fill out a reimbursement form.
I guess if I get sick with some kind of infection and need a one time prescription for two or three weeks, I’ll have to ride it out. I can’t afford these high co-pays. I think I,ll contact my congressman and see why this has happened. Just another way to shaft the Veterans.
I have BCBS FED and Tricare standard as secondary ins. I get Valsartan ( blood pressure med) and all of a sudden they want $14.00 co pay. I spend alot to have a great primary insurance co and they don’ t want to pay the rest. I have been getting the same 90 day supply for quite a while now and now all of a sudden want $14.00? My husband has cancer so we already have met our deductible. I call and even the supervisors don’ t give a knowledgeable answer.