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Tricare Changes Maintenance Meds Benefit


If you take certain name brand maintenance prescriptions, a new law will change your benefit.  As of October 1, 2015, non-active duty Tricare beneficiaries who use name brand maintenance medications are required to use either the Tricare mail order pharmacy or military pharmacies for these prescriptions.  Beneficiaries who keep using a retail pharmacy for these drugs will have to pay the full cost.

Maintenance drugs are drugs you take regularly for a long time, such as to control blood pressure or cholesterol.  Under the new rules, you have two choices for filling these prescriptions:  the Tricare mail order pharmacy program, or a military pharmacy.

Tricare Mail Order Pharmacy Program

The Tricare mail order pharmacy program is a convenient and low-cost option for medications that you take regularly.  It can take a little bit of effort to get your prescriptions set up in the system, but it is super-easy once you have it going.  Plus, you'll likely save money.  Tricare estimates that beneficiaries will save up to $176 per prescription each year.  Amy Bushatz has put together a great cheat sheet here at Mail-Order Those Drugs:  A Tricare How-To.

There are three ways to get a prescription into the Tricare mail order pharmacy system:  online, through e-prescribing, or via the regular mail.

  • You can move the prescription online at the Tricare pharmacy website.  This requires that you set up an account and take some steps to move the prescription.
  • You can also ask if your doctor uses an e-prescribing system that allows him or her to enter prescriptions electronically.  (It sounds complicated but I am assured it is not.  Ask!)
  • You can fill out a registration form and mail your paper prescription to Express Scripts.
If you have any questions or problems with these options, you can call the Member Choice Center at 1-877-882-3335 for more assistance.

Military Pharmacy

Tricare beneficiaries who wish to move their current retail prescription to a military pharmacy should plan ahead.  First, call or visit the pharmacy you plan to use to ensure that they carry your medications.  Then, learn their system, and perhaps see if you can figure out the times that they are super-busy.  Military pharmacies frequently have very long wait times (think hours), and outside prescriptions are sometimes the lowest priority category.

Sometimes military pharmacies participating in e-prescription programs that allow your physician to send the prescription to the pharmacy electronically.  You can see a list of participating military pharmacies on this PDF document.

If you have any questions or problems with these options, you can call the Member Choice Center at 1-877-882-3335 for more assistance.

What Drugs Are Changing?

If you take long-term medications, it might be hard to know whether your prescription falls under these new rules.  To check your medication, you can look up your prescription on the Select Drug List, or call Express Scripts at 1-877-363-1303.  If your medication falls on the Select Drug List, and you fill it at a retail pharmacy, you will get one covered refill after 1 October 2015.  After this date, you will be responsible for the full retail cost of the prescription.

When you get a new prescription for a drug that is listed on the Select Drug List, you can have it filled two times at a network pharmacy.  After that, you need to sign up for home delivery, or go to a military pharmacy, or pay the full retail cost of the drug at a retail pharmacy.

Who Doesn't Have To Follow These Rules?

This change does not apply to:
  • active duty military members,
  • short-term medications, such as antibiotics,
  • generic medications,
  • beneficiaries living overseas,
  • beneficiaries who have other prescription drug coverage,
  • beneficiaries who apply for and receive a waiver to continue having their prescriptions filled at a retail pharmacy.  The may apply in emergencies or in situations such as a beneficiaries living in a nursing home.  Waivers can be obtained by calling Express Scripts at 1-877-363-1303.
The Tricare pharmacy contractor, Express Scripts, sent a letter to affected beneficiaries in September explaining their options.   If you are confused or have any questions, you can contact Express Scripts at 1-877-363-1303. Show Full Article

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