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Tricare patients' deadline to switch pharmacy is Dec. 1

November 29, 2016
This story was updated on Nov. 30 to clarify the Tricare pharmacy out-of-network reimbursement rates.

It happens at 12:01 a.m. Thursday, Dec. 1 -- CVS leaves the Tricare retail pharmacy network and Walgreens returns.

Tricare patients who now use CVS should transfer their prescriptions to another pharmacy in the Tricare network, because if you have a prescription filled at a CVS pharmacy after Dec. 1, you'll pay full retail price. You can file a claim for partial reimbursement of the cost, but since CVS will be considered an out-of-network pharmacy, Tricare may reimburse only part of the cost.

The change also affects CVS pharmacies located within Target stores.
 
Express Scripts, Inc., the Tricare pharmacy contractor, announced Sept. 30 that they have reached a new network agreement with Walgreens, and that CVS pharmacies would leave the network.

Walgreens isn't the only place you can get prescriptions refilled. Express Scripts has agreements with a number of other pharmacies, including other national chains such as Rite Aid, grocery chains such as Safeway and independent pharmacies.

The new network will have more than 58,000 locations nationwide, according to Express Scripts. You can locate a pharmacy on the Express Scripts Tricare Pharmacy Program site. On Dec. 1, the CVS locations will be removed from that site and Walgreens locations will be added.

There are a number of ways to transfer the prescription to a new pharmacy, such as:

  • Take your prescription bottles to the new pharmacy, where the pharmacist will contact your previous pharmacy.
  • Call the new pharmacy and ask them to get your prescription drug information from your previous pharmacy. 
  • Ask your doctor to send prescription information to the new pharmacy.
There are other pharmacy choices, too, such as using military pharmacies, or using the Tricare Pharmacy Home Delivery. Find out if your prescription drug is eligible for the home delivery service by calling 855-778-1417. 

For those with other health insurance plans that are the primary payer, if you get the prescription filled at CVS, Tricare treats the balance of the claim after the other health insurance pays the same as it would a normal out-of-network claim, subject to deductibles, cost shares and copayments, depending on the plan, according to a Defense Health Agency official. 

Walgreens previously was a part of the Tricare Pharmacy Network, but left Tricare in 2011 in a dispute over drug discounts.

Patients who continue to use CVS as an out-of-network pharmacy must file a claim for reimbursement. Active duty members will get full reimbursement. Tricare Prime beneficiaries will pay 50 percent of the cost of their prescriptions after they meet the deductible; and Tricare Standard beneficiaries will pay a copay that depends on the formulary status or a 20-percent cost share, after they meet their annual deductible, according to an official with Defense Health Agency. 

For more information, visit the Tricare Pharmacy Program site.

Karen Jowers covers military families, Tricare, quality of life and consumer issues for Military Times. She can be reached at kjowers@militarytimes.com .  









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