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Departments - Answer Digest

TRICARE Pharmacy

Is it true that TRICARE has a new policy for prescriptions mailed overseas?

Yes. Military retirees living overseas who are eligible to receive mail through the military postal service now can receive prescription drug shipments weighing more than 
16 ounces. Previously, shipments had to be made in multiple packages, each weighing less than 16 ounces. 

Contracted suppliers for the TRICARE  Mail Order Pharmacy (TMOP) program now can mail a 90-day supply of prescription drugs, because of an exception to policy that otherwise would limit the weight of the packages. This exception, which was implemented May 21, is limited to prescription medication shipments, and no other suppliers or programs are authorized under this policy.

Currently, Express Scripts Inc. is the only authorized TMOP-contracted supplier. The company has a five-year contract with DoD as the sole supplier of prescription drugs under that program. 

What are the current cost-shares for retirees, their family members, and others using TRICARE?

The chart below lists current TRICARE cost-shares. The chart doesn’t apply to active duty family members.
If you have any questions about your benefits, you can reach TRICARE officials at the following phone numbers weekdays between 8 a.m. and 8 p.m. Eastern time. 

Phone calls will be answered in English only.

Senior Pharmacy Program, (877) DoD-MEDS (363-6337)
TRICARE For Life, (888) DoD-LIFE (363-5433) 
TRICARE Online, (866) DoD-EWEB (363-3932)
HIPAA, (888) DoD-HIPA (363-4472)
TRICARE Retiree Dental Plan, Delta Dental, (888) 838-8737
TRICARE Mail Order Pharmacy, Express Scripts, (866) 363-8667
Defense Enrollment Eligibility Reporting Systems (DEERS), (800) 538-9552 

TRICARE COST-SHARES
Fee category    TRICARE Prime TRICARE Extra TRICARE Standard
Annual
deductible 
None  $150/individual
or $300/family
$150/individual 
or $300/family
Annual 
enrollment fee
$230/individual 
or $460/family
None None
Civilian 
copayment:
   Outpatient
   Emergency care 
   Mental health 
As listed below:

$12 
$30 
$25 (individual)
$17 (group)
20% of negotiated fee for outpatient services 25% of allowed charges 
for covered service
Civilian inpatient cost share $11/day
($25 minimum)
charge per 
admission
Lesser of $250/day or 25% of negotiated 
charges plus 20% of negotiated professional fees
Lesser of $441/day or 25% of billed charges plus 25% of allowed 
professional fees
Civilian inpatient skilled nursing facility care $11/day
($25 minimum) 
charge per 
admission
Lesser of $250/day copayment or 20% 
of total charges for 
institutional services, 
plus 20% cost-
share of separately 
billed charges 
25% cost-share of allowed charges for 
institutional services 
plus 25% cost-share of allowable for separately billed charges
Civilian inpatient mental health $40/day 20% of institutional & negotiated professional fees Lesser of $164/day or 25% of allowable fees