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TRICARE Pharmacy
By Capt. Bud Schneeweis, USCG-Ret., Director; Lt. Col. William A. Pierce,
USA-Ret.; Cmdr. Katherine O’Neill Tracy, USNR-Ret.; and Phil Dyer,
CFP Benefits Information Benefits Information
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
| 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 |
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