[TFL] New Copays for TRICARE Pharmacy Customers & Other Pharacy Related Information
- From: TFL Mailing List
- To: <HEALTH.MIL@xxxxxxxxxxxxx>, <TFL@xxxxxxxxxxxxx>
- Date: Mon, 4 Feb 2013 10:54:42 -0600
New Copays for TRICARE Pharmacy Customers
2/1/2013
FALLS CHURCH, Va. - New copayments for prescription drugs covered by TRICARE
(went) into effect on February 1, 2013. The Fiscal Year 2013 National Defense
Authorization Act requires TRICARE to increase copays on brand name and
non-formulary medications that are not filled at military hospitals or clinics.
There is no increase to copays for generic medications.
TRICARE pharmacy copays vary based on the class of drug and where beneficiaries
choose to fill their prescriptions. The copay for generic medications stays at
$5 when a prescription is filled at a network pharmacy. There is no copay when
generic prescriptions are filled through TRICARE Home Delivery. The new copay
for a 30-day supply of a brand name medication purchased at a retail network
pharmacy will be $17, up from the current $12. Beneficiaries using TRICARE
Pharmacy Home Delivery will pay $13 for brand name drugs, up from $9. However,
the Home Delivery price is for a 90-day supply.
The greatest change in copays applies to non-formulary medications. The $25
copay for these drugs increases to $44 at retail pharmacies and $43 through Home
Delivery. The TRICARE Uniform Formulary is a list of all the medications TRICARE
covers.
For fiscal 2014 and beyond, the new law directs that copays increase annually by
the same percentage as retiree cost-of-living adjustments (COLA). In years when
a COLA increase would total less than a dollar, it will be delayed a year and
combined with the next adjustment so increases will always be $1 or more.
NOTE: For more COLA related info, please visit
http://militaryadvantage.military.com/2013/01/2013-retiree-and-veteran-cola-anno
unced/
Pharmacies at military hospitals and clinics will continue to provide
medications with no copays. See below or visit
http://www.TRICARE.mil/pharmacycosts for more details.
Prescription Cost Information
=============================
Prescription costs are based on the type of prescription and where it's filled.
1. Military Pharmacy:
a. $0 copayment for up to a 90-day supply of most medications.
b. Not all medications are available at military pharmacies. Call first to
check availability.
c. Non-formulary medications are not usually filled at military pharmacies.
2. Home Delivery - You may receive up to a ninety (90) day supply for most
prescriptions at the following costs:
a. $0 for generic formulary medications
b. $13 for brand-name formulary medications
c. $43 for non-formulary medications, unless you establish medical
necessity.
NOTE: For more information on Getting Medical Necessity for Non-Formulary
Drugs, please visit
http://www.tricare.mil/Prescriptions/Medications/Formulary/MedNecessity.aspx
3. Network Pharmacy - You may receive up to a thirty (30) day supply of most
medications at the following costs:
a. $5 for generic formulary medications
b. $17 for brand-name formulary medications
c. $44 for non-formulary medications, unless you establish medical
necessity.
NOTES: (1) For more information on Getting Medical Necessity for Non-Formulary
Drugs, please visit
http://www.tricare.mil/Prescriptions/Medications/Formulary/MedNecessity.aspx
(2) If you want to have a 90-day prescription filled, you will pay the
copayment for each 30-day supply.
4. Non-Network Pharmacy - You'll pay more to have prescriptions filled at
non-network pharmacies (including host nation pharmacies) and costs vary based
on your plan and the type of prescription.
a. Active duty service members will receive a full reimbursement after they
file a claim.
b. All others enrolled in a Prime option pay 50% cost share after the point
of service deductible is met.
c. Beneficiaries using Standard/Extra, TRICARE Reserve Select, TRICARE
Retired Reserve or TRICARE Young Adult pay:
(1) Formulary-Generic or Brand Name: $17 or 20% of the total cost,
whichever is greater, after the annual deductible is met
(2) Non-Formulary: $44 or 20% of the total cost, whichever is greater,
after the annual deductible is met
TRICARE provides a world-class pharmacy benefit and has partnered with
Express-Scripts, Inc. for home delivery and retail network pharmacy services.
Register online at http://www.express-scripts.com/TRICARE/ to manage your
prescriptions or download the free Mobile App at
http://www.express-scripts.com/mobile/. Following additional TRICARE
prescription related information, services, etc., are also available online at
the links indicated:
- Eligibility for Prescription Coverage
<http://www.tricare.mil/Prescriptions/Eligibility.aspx>
- Filling Prescriptions
<http://www.tricare.mil/Prescriptions/FillPrescriptions.aspx>
- Medications <http://www.tricare.mil/Prescriptions/Medications.aspx>
- Prescription Costs <http://www.tricare.mil/Prescriptions/Costs.aspx>
- Pharmacy Claims <http://www.tricare.mil/Prescriptions/Claims.aspx>
- Pharmacy Appeals <http://www.tricare.mil/Prescriptions/Appeals.aspx>
- Search the TRICARE Uniform Formulary
<http://pec.ha.osd.mil/formulary_search.php>
-------
SOURCE: TRICARE Website at http://www.tricare.mil/
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