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Unsure of what you want? Start here. There are links that will help you find anything you might need.
TRICARE beneficiaries living in the Charleston SC area can use the South Region link to find providers in that area.
Walgreens no longer a TRICARE pharmacy provider
FALLS CHURCH, Va. – The expiration of the retail pharmacy contract between Express Scripts, Inc. and the Walgreens pharmacy chain means Walgreens is no longer a TRICARE pharmacy network provider as of Jan. 1.
“The majority of beneficiaries have access to another network pharmacy very close to home as our pharmacy contract requires ESI to maintain high-access standards,” said Rear Adm. Thomas McGinnis, chief of the TRICARE Pharmaceutical Operations Directorate. “There are still 56,000 network pharmacies nationwide -- easily meeting or exceeding our access requirements.”
Besides 56,000 network pharmacies, TRICARE beneficiaries have other pharmacy options including military pharmacies at no cost and TRICARE Pharmacy Home Delivery. Generic medications are available at no cost through Home Delivery.
Beneficiaries who use non-network pharmacies, including Walgreens, pay full prescription costs upfront and submit their own claims for reimbursement. Reimbursement will occur only after the non-network deductible is met. Out-of-network costs include a 50 percent point-of-service cost share for TRICARE Prime, after deductibles are met. All other non-active duty TRICARE beneficiaries pay the greater amount of a $12 co-pay or 20 percent of the total cost for formulary medications, and the greater of $25 or 20 percent of the total cost for non-formulary medications, after deductibles are met.
For more on pharmacy costs, visit www.tricare.mil/pharmacycosts.
TRICARE beneficiaries changing from Walgreens pharmacy can simply take their current prescription bottle to their new network pharmacy to have the prescription transferred. To find a nearby network pharmacy, use the “find a pharmacy” feature on www.express-scripts.com/tricare. Beneficiaries who want help finding a pharmacy, changing their medications to Home Delivery, or who have other questions can contact Express Scripts at 877-885-6313.
The issues between ESI and Walgreens are not specific to TRICARE. Other employer-sponsored and some Medicare Part D pharmacy plans are also affected. Beneficiaries with questions and concerns about this issue can go to www.tricare.mil/walgreens for more information.
“We are committed to ensuring all our pharmacy beneficiaries are aware of the many options that TRICARE makes available to them,” said Brig. Gen. Bryan Gamble, TRICARE deputy director. “By now, all of our beneficiaries who use Walgreens to fill prescriptions should have been contacted to advise them of their pharmacy options and to take action to ensure their pharmacy benefit remains uninterrupted.”
For more retiree news and information, please visit www.retirees.af.mil.
Source: Air Force Retiree News Service [usairforce@public.govdelivery.com] Release No. 01-02-12
Jan. 4, 2012
Copayment for TRICARE Meds Changing Oct. 1
As reported last month, TRICARE will soon change their pharmacy copayments to encourage TRICARE beneficiaries to use the Home Delivery option.
As of Oct. 1, 2011, copayments for generic prescription medications will be free of charge for 90 day supplies through TRICARE Home Delivery; while the copayment for the same medication will increase from $3 to $5 at retail pharmacies.
The following changes to the TRICARE pharmacy copayments are scheduled to go into effect
on Oct. 1:
Generic formulary drugs purchased at retail pharmacies will go from $3 to $5.
Generic formulary drugs purchased through the Home Delivery option will go from $3 to $5 for a 90 day supply.
Brand name formulary drugs from retail pharmacies will go from $9 to $12.
Non-formulary medications will go from $22 to $25 in both retail and Home Delivery.
Brand name formulary drugs purchased through Home Delivery will have the same $9 copayment.
READ THE ARTICLE BELOW ABOUT TRICARE HOME DELIVERY.
TRICARE 'Home Delivery' Convenience
TRICARE Pharmacy Home Delivery allows beneficiaries to save time and money by delivering maintenance medications safely and securely to their home through the U.S. Mail.
TRICARE beneficiaries who still get two or more maintenance prescriptions for chronic conditions from a retail pharmacy should start checking their mailboxes. TRICARE Management Activity and Express Scripts Inc. (ESI) are mailing out home delivery education "alert" letters in July to promote pharmacy home delivery. For more information about home delivery, visit the TRICARE Pharmacy Home Delivery webpage at www.tricare.mil/homedelivery.
To sign up for home delivery, beneficiaries should go to the Express Scripts Inc. website, www.express-scripts.com/TRICARE, or call the TRICARE Member Choice Center at 877-262-3390.
TRICARE beneficiaries switching to pharmacy home delivery from retail pharmacies in 2010 saved 66 percent on their copayments, up to $176 a year for a non-formulary prescription. Pharmacy home delivery also features an automatic prescription refill option.
AND MORE INFO BELOW TO MAKE YOUR LIFE EASIER.
TRICARE Expands Prescription Service
E-prescribing offers convenience and lower costs to TRICARE beneficiaries by giving healthcare providers easy access to the TRICARE Uniform Formulary.
TRICARE is encouraging all providers to begin using E-prescribing for TRICARE beneficiaries.
For TRICARE beneficiaries who choose to receive their prescriptions through home delivery, providers can submit a prescription via E-prescribing to TRICARE Pharmacy Home Delivery. However, E-prescriptions cannot be routed to Military Treatment Facility pharmacies at this time.
To learn more about Home Delivery, visit the TRICARE website.
New TRICARE Formulary Search Tool
Beneficiaries and providers can use the new TRICARE Formulary Search Tool to find which prescription medicines are in the uniform formulary. Once a user has identified if a drug is available, they can use the search tool to get information on a drug, such as restriction on use.
The tool also shows if the medication is Tier One (with a $3 copay,) Tier Two (with a $9 copay) or non-formulary (requiring a $22 copay.) It also shows when a generic equivalent is required. The new Tool also has integrated the Prior Authorization and Medical Necessity forms and criteria into a search engine while still maintaining a page with a complete list of all criteria and forms. Any restrictions such as quantity or age limits are displayed in one location.
In the future, the search tool's functionalities will increase based on feedback provided by patients and providers.
TRICARE Offers Free Vaccines (Including Shingles)
Defense officials have announced that TRICARE will now offer free vaccines – including shingles vaccine for beneficiaries age 60 and older – through their retail pharmacy network.
Free vaccines previously were only offered only in military hospitals and clinics.
See what vaccines are offered through the TRICARE network and make sure you're up to date on all of your preventative vaccines.
TRICARE recommends calling your pharmacy in advance to ensure the vaccine is in stock and a pharmacist is available to administer it.
MOAA strongly applauds this outstanding initiative, which is particularly helpful to TRICARE For Life beneficiaries, who previously had to pay up to $150 out of pocket for the shingles vaccine.
Unfortunately, refunds can't be provided for beneficiaries who previously paid for the vaccine before the new program was instituted.
TRICARE survivor benefits continue upon death of sponsor
8/2/2011 - FALLS CHURCH, Va. (AFNS) -- TRICARE will continue to provide coverage for family members if a sponsor dies. Options and costs will vary based on the sponsor's military status when he or she dies and if the surviving beneficiary is a spouse or child
If a beneficiary is the spouse of an active duty service member who died while on active duty, the beneficiary remains eligible for TRICARE as a "transitional survivor" for three years following the sponsor's death and will have active duty family member benefits and costs.
After three years, a beneficiary remains eligible, as a "survivor," for TRICARE Standard and TRICARE Extra, and may purchase TRICARE Prime at the retiree rates. If a beneficiary is overseas, he or she remains eligible for TRICARE Overseas Program TOP Standard once the transitional survivor status ends.
If a beneficiary is the child of an active duty service member who died while on active duty, he or she remains eligible for TRICARE benefits as an active duty family member. His or her transitional survivor status ends at age 21, or 23 if the beneficiary is enrolled in a full-time course of study.
In the United States and U.S. territories, the pharmacy benefit remains the same regardless of the TRICARE program option the beneficiary uses. Beneficiaries may fill prescriptions through a military treatment facility, TRICARE Pharmacy Home Delivery, TRICARE retail network pharmacies or a non-network pharmacy.
The TRICARE Dental Program Survivor Benefit Plan is a three-year benefit for transitional survivors offering the same coverage as the regular dental plan. The beneficiary will have no monthly premiums but is responsible for paying applicable cost-shares for covered services.
If enrolled in the dental plan at the time of the sponsor's death, the beneficiary will be dis-enrolled from the TRICARE Dental Plan and enrolled in the TDP Survivor Benefit Plan.
When the TDP Survivor Benefit Plan ends, the beneficiary is eligible for the TRICARE Retiree Dental Program. The TRDP also may be available if the beneficiary doesn't qualify for the TDP Survivor Benefit Plan because he or she was not enrolled in the TDP at the time of his or her sponsor's death.
It is important that all information in the Defense Enrollment Eligibility Reporting System is up-to-date for this process to move quickly and smoothly.
For more detailed information of TRICARE Survivor Benefits and other TRICARE programs, beneficiaries can go to TRICARE's website or talk with their regional health care manager.
Fact and Fear Over TRICARE Access
If there’s a soul in the military community who isn’t worried over his or her health care access, he or she probably isn’t paying attention.
There’s good reason to be concerned about what could happen in the future, and it’s also true that there are some places where access is already a challenge. But despite those concerns, the large majority of military beneficiaries still have pretty good access as of today.
The last statistics I saw on the subject indicated that about 93% of US health providers accept Medicare. That’s not to say there aren’t doctors who have stopped doing so and others who are considering it. But most haven’t gotten to that point so far.
Similarly, every time we’ve gone out and solicited MOAA members to tell us whether they’re having access problems, we’ve been surprised that 85+% of the respondents have indicated no current problems. We figured that when we actively solicit members to tell us their probems, we’d get a disproportional share of responses from members who are having difficulty.
And it appeared from the comments of respondents that most who did report having difficulty were experiencing a problem with a particular specialty or with continuing to see a specific doctor they liked.
In that regard, having your doctor stop taking TRICARE is a problem and inconvenient whenever it happens, but if there are other providers available in your area who will see you, it’s not a complete health care crisis.
A recent GAO report acknowledged that there are some locations where access is a real problem, and we’ll have to push Defense leaders to find ways to help those localities.
There’s also a legitimate concern about whether the annual threats of major cuts in Medicare and TRICARE payments to doctors could dramatically alter doctors’ willingness to participate in those programs in the future.
So the fear is legitimate, regardless of your current health care access status. But let’s not let the fear color our perspective. While we need to continue pushing Congress to act to prevent a broad crisis from happening, we shouldn’t let the necessary discussion on this topic confuse us into thinking the broad population is already having problems.
If it’s your community that has an access problem, it’s real, and it doesn’t matter to you what’s happening elsewhere. But for most people, that’s not the case. Our hope is to keep it that way.
Published by Col. Steve Strobridge, USAF-Ret. at 10:11 am under Health Care News at MOAA.org
Fanning Healthcare Flames
The Congressional Budget Office added to the healthcare debate this week with a new projection that Pentagon estimates of military cost growth over the next five years are likely understated by $25 billion.
On healthcare, CBO noted that DoD drug costs grew by an average 2.2% per year from 2006 to 2010, vs. the national average of 1.2%.
MOAA's response: No kidding. Might that have something to do with overstressing military people and families with repeated deployments for the last decade? Check the quote of the week (see sidebar).This cost growth isn’t a beneficiary imposition. It's a DoD responsibility.
CBO reports that military personnel costs over the next five years are projected to grow by $5 billion, procurement costs will grow by $36 billion, and operations and maintenance costs will grow by $26 billion.
In that context, MOAA finds it somewhat incongruous that Defense leaders keep singling out personnel costs as "eating us alive."
TRICARE & ID Card Changes
TRICARE beneficiaries should make sure they have their Social Security number committed to memory. It won’t be found on new Department of Defense ID cards.
As of June 1, 2011, SSNs are no longer printed on new ID cards issued to members of the Uniformed Services, retirees and family members. The new cards will look basically the same, but will have a unique DoD Identification number in place of the SSN. For those eligible for benefits, such as health care, a DoD Benefits number (DBN) will be on the back.
The elimination of visible SSNs is a DoD response to the increasing need to protect the privacy and identity of ID card holders, but it may raise questions when it comes to obtaining health care or pharmacy benefits. Health care providers have always used social security numbers to check TRICARE eligibility and file claims.
For TRICARE beneficiaries, the DBN is most important. Many systems can accept it already, but beneficiaries using the Military Health System and TRICARE should be prepared to state their SSN (or their sponsor’s) when accessing health care or pharmacy benefits.
The change to new IDs for all members and families is expected to take about four years. Existing ID cards are good until they expire; including retiree cards marked “INDEF.” Beneficiaries who want a new ID without their SSN are advised to make an appointment before making the trip to an ID card facility.
TRICARE beneficiaries and providers can get more information, see ID card samples and view frequently asked questions at Tricare.
General information about the removal of SSN from ID cards can be found at DMDC.
New Features Allow Users Access To Expanded Personal Health Data At TRICARE Online
A new feature on TRICARE Online now allows users access to expanded personal health data, including lab results, patient history and diagnoses, and provider visits.
These features are an expansion of the current Blue Button capability, which already allowed beneficiaries to safely and securely access and print or save their demographic information, allergy and medication profiles. The Blue Button features will further encourage beneficiaries to actively engage in their health care. The level of data available will be dependent on where treatment occurs, with the most data available to those who regularly get care at military hospitals and clinics.
The Blue Button was fielded by TRICARE and was made generally available by other federal health care providers in 2010. It is the result of a close interagency partnership between the Department of Defense, the Centers for Medicare and Medicaid Services and the Department of Veterans Affairs. Blue Button already has over 250,000 users.
TRICARE Online (TOL) is the Military Health System's Internet point of entry that provides all 9.6 million TRICARE beneficiaries access to available health-care services and information through an enterprise-wide secure portal. TOL users who receive their care at a military treatment facility can schedule appointments, order prescription refills and view their personal health data. Other TOL users with active prescriptions at a military pharmacy can also request a refill for those prescriptions.
To learn more, go to Tricareonline or visit Military Health System. For more news about health IT news, subscribe to The Portal, the leading news source for military health IT at Military Health System Office of the Chief Information Officer.
TRICARE for Newborns
Newborns and adopted children must be registered in the Defense Enrollment Eligibility Reporting System (DEERS) before they can be enrolled in any TRICARE health plans. Parents do not need to know their child's social security number to complete the registration process, but they need to add the number in DEERS when it becomes available. Parents can apply for their newborn's social security number by calling 800-772-1213.
To register their child in DEERS, parents must submit documents to their local identification card office, which can be found on the RAPIDS site locator website.
For more information on children and TRICARE, visit TRICARE's Who's Eligible website.
For more information about DEERS, visit the TRICARE DEERS webpage at www.tricare.osd.mil/deers.
TRICARE Guidelines for Traveling
Here are guidelines to insure that your TRICARE service is available if you plan to travel. Prior to your departure, verify that your information and your family's information is up to date in the Defense Enrollment Eligibility Reporting System (DEERS). Pack your uniformed services ID card and TRICARE Prime/TRICARE Prime Remote enrollment card, which you may need to present if you need medical care or prescriptions refilled. Call the number (1-877-874-2273) on the back of your enrollment card to find out what to do prior to seeking care or if you are hospitalized. Schedule any routine care with your Primary Care Manager (PCM) before you travel. Urgent care must be coordinated in advance with your PCM.
TRICARE For Retired Reservists
Retired reservists can now get a DoD Self-service Logon (DS Logon) account at any TRICARE Service Center (TSC) worldwide. Once they have a DS Logon, they can use it to go online to purchase TRICARE Retired Reserve (TRR) health care coverage. To locate the nearest TSC, visit the TRICARE website at www.tricare.mil/contacts.
Retired reservists may also still go to designated VA regional offices to complete in-person-proofing and get a DS Logon account. To locate a VA regional office, visit the VA website.
For more information about TRICARE's health care benefits for members of the Reserve and National Guard, visit the TRICARE website at www.tricare.osd.mil/reserve.
TRICARE provides u-to-date information in a disaster
TRICARE provides up-to-date information before, during and after a disaster at www.tricare.mil/disasterinfo. Sign up to receive disaster e-mail updates at the TRICARE website.
