TRICARE Senior Pharmacy

On April 1, 2001, uniformed services beneficiaries 65 years of age and over became eligible for the TRICARE Senior Pharmacy Program, which authorizes eligible beneficiaries to obtain low-cost prescription medications from the TRICARE Mail Order Pharmacy (TMOP) and TRICARE network and non-network civilian pharmacies. Beneficiaries may also continue to use military hospital and clinic pharmacies. The TRICARE Senior Pharmacy Program replaces the Base Realignment and Closure pharmacy benefit and the Pharmacy Redesign Pilot Program. The following is a summary of this program:

• Eligibility Requirements
• Filling Your Prescriptions
• Military Treatment Facility Pharmacy
• Prescriptions by Mail
• TRICARE Network Pharmacies
• Non-Network Pharmacies
• TRICARE Enrollment and Claims Forms

Eligibility Requirements

This pharmacy program is open to uniformed services beneficiaries age 65 and over. However, you must be registered in the Defense Enrollment Eligibility Reporting System (DEERS), and the new benefits may require you to be enrolled in Medicare Part B.

Those who turn 65 on or after April 1, 2001, MUST be enrolled in Medicare Part B in order to use the mail order and retail pharmacy benefits. The Department of Defense encourages everyone to carefully consider enrollment in Medicare Part B so they will have comprehensive health care and will be eligible to take advantage of other TRICARE health benefits that will begin October 1, 2001.

Filling Your Prescriptions

You can use military treatment facilities (MTF) pharmacies, TMOP and Retail Pharmacies.

Military Treatment Facility Pharmacy

You can continue to get available medications at no charge through military treatment facility pharmacies. Simply present your written prescription to the pharmacist, or follow procedures established by your MTF.

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Prescriptions by Mail

For prescriptions you take regularly, such as medication to reduce blood pressure, or to lower cholesterol or treat diabetes, a convenient TRICARE Senior Pharmacy option is the TRICARE Mail Order Pharmacy (TMOP). Through this program, you simply mail your health care provider's written prescription along with your payment, and you can receive up to a 90-day supply of most medications. (For some medications there are applicable quantity limits). After the military treatment facility, TMOP is the least expensive option for both you and the government. To fill your prescriptions, you will also need to register with the TMOP by completing and sending in a registration form, which you can obtain by calling toll free, 1-800-903-4680.

In addition, you must ensure that the Defense Enrollment Eligibility Reporting System (DEERS) has your current address. To update your address in DEERS, call 1-800-538-9552 (for California, 1-800-334-4162; for Alaska and Hawaii, 1-800-527-5602), or visit the DEERS website.

Prescription drugs purchased through TMOP are only $3 for up to a 90-day supply of generic medications, or $9 for up to a 90-day supply of brand name medications. Credit card payment is encouraged and is one of the easiest ways to pay for prescriptions obtained through TMOP. For additional information, please visit Express Scripts or call Express Scripts, toll free, at 1.866.DOD.TMOP (866.363.8667).

TRICARE Network Pharmacies

The TRICARE network pharmacies are retail pharmacies that have contracted with TRICARE to serve its beneficiaries. If you need a prescription filled immediately, such as an antibiotic or a pain medication, visit one of these approved network pharmacies. You can receive up to a 30-day supply of medication at a time for each prescription. You pay only $9 for a 30-day supply of brand-name prescription drugs, and $3 for a 30-day supply of generic prescription drugs - more than with TMOP, but far below the retail price. Simply present the pharmacist with your written prescription and military ID card. For a list of TRICARE network pharmacies in your area, contact the TRICARE service center nearest you or visit the TRICARE Website.

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Non-Network Pharmacies

Non-network retail pharmacies are the most expensive option. Eligible beneficiaries usually receive reimbursement of 80% of the full retail price for medications, after you have met the TRICARE annual deductible amount ($150 per individual,$300 per family). In most cases, you must pay the full retail price at the pharmacy and then file a claim for appropriate reimbursement. The reimbursement form is called the CHAMPUS Claim: Patient's Request for Medical Payment (DD Form 2642). The form is available from a health benefits advisor at a military treatment facility, or by mail from TRICARE Management Activity, 16401 E. Centretech Parkway, Aurora, Colorado 80011-9043. For additional information on filing claims, visit the TRICARE website.

The following chart shows an example of the costs for the same medication using each of the four options. This example uses the co-pay amount for brand name drugs. The savings will be even greater for generic drugs.

For general information about TRICARE, call the toll-free TRICARE information line for your region found at the TRICARE Contact Us web page.