Tricare: Pharmacy Program - Military Health, Tricare programs - Military Times

Tricare: Pharmacy Program

Military beneficiaries can get prescription drugs free at military clinics or hospital pharmacies. For a fee of $3 for a generic and $9 for a brand name, they can get a 30-day supply at participating Tricare retail stores. They can get a 90-day supply of the same drugs at the same price through the Tricare Mail Order Pharmacy Program.

A beneficiary cannot use the mail-order pharmacy if another pharmacy benefit is available, unless the medication is not covered under the other plan or the dollar limit of the other plan is exhausted.

A third tier of coverage has been created that charges $22 for some brand-name drugs that are not on the Defense Department’s pharmacy formulary. Defense officials have gradually been moving more brand-name drugs to this pricing tier in recent years to encourage beneficiaries to use equally effective generics, which helps hold down the Defense Department’s costs.

Tricare users pay more for the drugs on this third tier, but will not have to pick up the full costs, unlike some commercial health plans.

Beneficiaries can have their prescriptions filled at a store not in the Tricare network, but they pay 20 percent of the retail cost of the drug, or $9, whichever is greater. They also pay annual deductibles. Lower enlisted paygrades — E-4 and below — not in Prime are charged a $50 deductible for an individual and $100 for a family. Everyone else not in Prime pays $150 for an individual or $300 for a family.

Prime enrollees who use pharmacies outside the network also pay deductibles of $300 per person or $600 for a family. They also have a 50 percent co-pay for the drugs.

In its 2009 budget request, the Defense Department has proposed increasing the co-pays for drugs obtained through retail pharmacies and for some mail order options, with the exception of generic mail order prescriptions, which would be reduced to zero cost.

Most retirees 65 or older must have Medicare Part B to use Triage’s retail and mail-order pharmacy programs. Only retirees and dependents who turned 65 before April 1, 2001, are not required to carry Part B to use the pharmacy benefits, but Part B is needed if they want medical benefits.

Contact: (866) 363-8667 (Tricare mail order) or (866) 363-8779 (Tricare Retail Pharmacy); http://www.tricare.mil/ mybenefit/home/Prescriptions