October 2, 2015
The 2015 National Defense Authorization Act (NDAA) requires TRICARE beneficiaries to get some prescription maintenance drugs from the TRICARE Pharmacy Home Delivery or a military pharmacy starting October 1, 2015. This change initially affects 195,000 beneficiaries.
Q. What are the changes to the TRICARE Pharmacy Program?
Starting October 1, 2015, TRICARE beneficiaries must get some prescription maintenance drugs through the mail-order system or a military pharmacy. The change doesn’t apply to active duty servicemembers, beneficiaries who live overseas, and beneficiaries who have other health insurance with a prescription benefit.
Q. Why the change?
The 2015 NDAA requires the change. Retail pharmacies are the most expensive option for beneficiaries and the DoD. Military pharmacies or home delivery options provide savings to both beneficiaries and the government.
Q. How will I know if the change affects me?
Express Scripts, TRICARE’s prescription contractor, should have mailed letters to beneficiaries affected by the change. Beneficiaries may also call Express Scripts to find out if the change applies to their maintenance drug.
Q. What if I missed the Oct. 1 deadline?
Affected beneficiaries who did not switch required maintenance prescriptions into the mail-order system by Oct. 1 should receive a reminder letter from Express Scripts. If medications are still not switched into the system, beneficiaries will be required to pay the full cost.
Q. Can I opt-out after participating for one year (like the TFL Pharmacy Pilot)?
No, there is no option to opt-out. Waivers may be available to beneficiaries with special circumstances, such as living in a nursing home. Beneficiaries must call Express Scripts at 1-877-363-1303 to request a waiver.
Q. Where can I find a list of affected medications?
Beneficiaries can check the health.mil website or call Express Scripts at 1-877-363-1303 to find out if the change applies to their maintenance drug.
Q. Who can I call for help if I have questions?
Have beneficiaries call Express Scripts at 1-877-882-3335.
Q. I live in Arizona, where temperatures routinely are over 100 degrees. Won’t drugs lose their potency if they ride around in a hot mail truck all day or sit on a porch or in a mailbox?
Express Scripts’ TRICARE distribution center is located in Tempe AZ. Officials say the temperature issue is mainly a longer-term storage concern. Sitting in a delivery vehicle or mailbox at higher temperatures will not cause a loss of potency for most drugs. Any potentially affected prescriptions are mailed in special temperature-controlled packaging and closely tracked to delivery.
Q. My wife and I get our prescriptions from a military pharmacy. Will we have to sign up for mail-order refills and stop going to the base?
No. Beneficiaries can still get refills through military pharmacies if they choose. The restriction on maintenance medication refills only applies to retail pharmacies, not military pharmacies.
Q. My spouse has had difficulty obtaining a prescribed narcotic from the mail-order pharmacy. The prescription is only for a 30 day period then requires a new one. How will this be handled?
Only refillable medications will be affected by the mail-order/military pharmacy requirement. Narcotic drugs will be excluded from the requirement. Although some narcotics may be used for chronic conditions, all narcotics are excluded from the mail-order mandate.
Q. How do I contact Express Scripts to set up a mail-order account and get my prescriptions transferred?
Beneficiaries can go to the Express Scripts website, or call 1-877-882-3335.