Tricare for Life beneficiaries reminded of mail-order Rx requirement
By Patricia Kime
Tricare has begun notifying military retirees and family members who use Tricare for Life that they must start filling long-term prescriptions by mail or at a military treatment facility starting next month.
Under the five-year pilot program, TFL beneficiaries must transfer prescriptions for maintenance medications to — or start new medications for chronic conditions through — the Tricare Mail Order Pharmacy or a military pharmacy by March 15.
Army Maj. Gen. Richard Thomas, director of health care operations for the Defense Health Agency, started notifying beneficiaries Tuesday by mail of the pending change.
According to Thomas, Tricare will no longer cover the cost of these medications at retail stores after two “courtesy fills” beyond March 14.
The requirement applies to long-term medications only, not those needed for acute illnesses or pain medications prescribed for a limited time. It also will not apply to prescriptions covered by other health insurance or generic medications, according to the Defense Department.
Pentagon data show that nearly half of the 70 million prescriptions filled for Tricare beneficiaries at retail pharmacies in fiscal 2012 were for TFL beneficiaries, at a cost of $2.2 billion to the government.
Since DoD pays 17 percent less for maintenance medications filled by mail than those filled at retail stores, Pentagon analysts concluded that costs could be trimmed significantly — by at least $120 million a year — if TFL beneficiaries were required to use mail order for long-term prescriptions.
The requirement also will save beneficiaries money: a 90-day refill of a generic medication costs nothing by mail, but require a $5 co-payment for a 30-day prescription at retail stores. Brand-name drugs cost $13 for a 90-day prescription by mail but $17 for a 30-day prescription at a store.
Medication is dispensed free at military treatment facility pharmacies.
Case-by-case waivers may be granted for personal hardship, emergency or “other special circumstances,” such as living in a nursing home, according to the rule published in the Federal Register. Waiver requests would have to be made through Express Scripts, Tricare’s pharmacy contractor.
The five-year pilot mail-order program was mandated by the 2013 National Defense Authorization Act. Under the law, beneficiaries can opt out of the program after one year, starting from the date they fill their first prescription through the program.
Refills can be ordered by calling 1-877-363-1303 or by visiting Express Scripts online.
Patients who want to start getting their medications at a military treatment facility may need to get a new prescription from their doctor, Pentagon officials said.