February 21, 2014

Beginning March 15, TRICARE For Life (TFL) beneficiaries will be required to fill maintenance medication prescriptions refills through the TRICARE Home Delivery (mail-order) pharmacy system.   

Beneficiaries can opt out of this requirement after using the mail-order refill system for one year. 

The new requirement stems from the FY 2013 defense authorization bill. In a bipartisan compromise to avoid large, across-the-board TRICARE pharmacy copay increases, Congress included a mandatory mail-order pilot program for TFL beneficiaries to offset the cost. 

Mail-order pharmacy delivery lowers costs for both beneficiaries and DoD. A 90-day refill of generic medication is free through the mail-order pharmacy, but costs $5 per 30 day refill at a retail drug store. For brand name medications the cost is $13 for a 90 day refill through mail-order versus $17 for a 30 day refill at a retail store.

The mandate applies to a group of brand name maintenance medications. Generic medications are exempt from the mail order requirement. If the beneficiary has not switched to home delivery or to a military treatment facility, starting with the third fill of that same medication after March 14, the beneficiary will be responsible for the entire cost of the medications if obtained from a retail pharmacy.    

All initial prescriptions can still be filled at a retail store, and beneficiaries can receive up to two 30 day refills at a retail store during the transition.

Beneficiaries living near a military hospital or clinic may continue to fill their prescriptions on base and do not need to enroll in the mail order program. Additionally, those with other prescription coverage and those living overseas also are exempt. 

Nursing home patients are also eligible for exemption from the mail order requirement. Caregivers can call the number below with prescription information to opt out, and Express Scripts will also be reaching out to nursing homes to assist with the process.

TRICARE will begin reaching out to affected beneficiaries over the next month. You can enroll online or over the phone at 1-877-882-3335. 

Individual waivers to opt out of the requirement may be granted on a case-by-case basis due to personal need or hardship, emergency, or other special circumstance.