TRICARE Pharmacy Changes Coming

October 2, 2015

Starting Oct. 1, most TRICARE beneficiaries are required to fill their long-term prescriptions via mail-order or through military treatment facility (MTF) pharmacies.

What began as a pilot program for TRICARE For Life (TFL) beneficiaries in 2013, a provision in last year’s defense bill expanded the mail-order program to all TRICARE beneficiaries. However, unlike the pilot program, beneficiaries will not have the option to opt-out of the program after one year.

Maintenance medications are used to treat long-term conditions like high blood pressure, high cholesterol, and diabetes.

According to the Defense Health Agency, moving TFL beneficiaries into the mail-order program helped result in almost 80 percent of the cost savings the agency claims.

“The overwhelming majority of people using mail-order give the program positive reviews for convenience and cost-savings,” said Capt. Kathy Beasley, USN (Ret), Deputy Director of Government Relations at MOAA. “While it unfortunately restricts some choice for beneficiaries, this is one of the few programs that actually saves both the user and the government money.”

Using mail-order for a 90 day supply of medication saves 66 percent from what retail locations charge.

In previous MOAA surveys, almost 97 percent of respondents gave the mail-order program favorable ratings.

By now, most TRICARE beneficiaries should have received notices about switching maintenance medications into the mail-order system.

Three categories of beneficiaries are exempt from the new requirements:

  • Beneficiaries currently serving on active duty

  • Beneficiaries with other health insurance (OHI) that provide drug coverage; and

  • Beneficiaries living overseas

Beneficiaries using maintenance medications need to enroll in the mail-order system or obtain medications through MTF pharmacies.

If you are unsure if your prescriptions are affected, you can call the number provided by Express Scripts: 1-877-882-3335.

For more information on the TRICARE Mail Order Program, check out MOAA’s Frequently Asked Questions.