TRICARE has implemented a Pharmacy Pilot Program for all TRICARE For Life recipients living in the US and territories. This program requires you to to fill select maintenance medications via TRICARE Pharmacy Home Delivery or use a military pharmacy instead of using retail pharmacies.
Maintenance medications are those you use on a regular basis for chronic health conditions (e.g., high cholesterol, blood pressure). These do not include medications needed for a sudden illness or infection. As part of the pilot program, TRICARE will stop paying for these medications from a retail pharmacy. The program does not apply to medications for acute conditions taken for a limited time, such as antibiotics or pain medications or any generic medications. At this time, it also does not apply to generic drugs.
Congress mandated the pilot program in the 2013 National Defense Authorization Act. It will last for five years, but beneficiaries may choose to opt out after filling an affected prescription under the pilot program through Home Delivery for one year.
Beneficiaries will be notified if they are taking a medication covered under the program. They will have two “courtesy fills” available through a retail pharmacy before they are responsible for the entire cost of their medication.
Beneficiaries may call the TRICARE pharmacy contractor, Express Scripts, at 877-882-3335 or visit the Express Scripts website to switch to Home Delivery or with questions about their medications. To switch a prescription to a military pharmacy, beneficiaries may need to get a new prescription from their doctor, officials said.
Some people are exempt, including people with another prescription drug plan or people living overseas. People living in a nursing home may contact Express Scripts to request a waiver from the pilot program. If you live OCONUS you still can get your prescriptions via TRICARE with no changes.
See the TRICARE For Life Pharmacy Pilot Program page for more information.