TFL Mandatory Mail-order Rx Coming

December 20, 2013

Beginning February 14, 2014, TRICARE For Life (TFL) beneficiaries will be required to fill maintenance medication prescription refills through the TRICARE Home Delivery (mail-order) pharmacy system. Beneficiaries may opt out after using the mail-order refill system for a one year trial period.

The change 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 requirement to offset the cost.

The mail-order pharmacy system 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 maintenance medications only. Initial prescription can be filled at a retail store, and beneficiaries can fill up to two 30-day refills at a retail store during the transition.

Beneficiaries living near a military hospital or clinic can continue to fill their prescriptions there and do not need to enroll in the mail order program. Additionally, nursing home patients and those with other prescription coverage are also exempt.

TRICARE will begin reaching out to affected beneficiaries over the next month. You can enroll online or over the phone at 1-877-363-1303.

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.