Upcoming Changes to TRICARE Pharmacy Benefit

  • Published
  • By Maj. Daniel J. Oh
  • 47th Medical Support Squadron
A new law going into effect Oct. 1, 2015 requires most TRICARE beneficiaries to receive brand name maintenance medications from TRICARE Pharmacy Home Delivery or a military pharmacy.  If beneficiaries continue using a retail pharmacy for these medications, they will have to pay the full cost. Active duty service members are exempt from the law's requirement.

Maintenance medications are those taken regularly for an extended period of time, such as medications to control blood pressure or cholesterol. The law does not apply to medications you take for a short time, such as antibiotics or generic drugs. The law also does not apply to beneficiaries living overseas or who have another insurance plan with prescription medication coverage.

Beneficiaries affected by the change will receive a letter from Express Scripts, Inc., the TRICARE pharmacy contractor. These letters will inform beneficiaries if they are taking an affected medication in terms of this policy and will explain their options. Beneficiaries can also call Express Scripts at 1-877-363-1303 to obtain additional information.

Following Oct. 1, Express Scripts will send another letter to beneficiaries who continue using a retail pharmacy for affected medications.  After that, beneficiaries have one more chance to fill these prescriptions at a retail pharmacy before they have to pay 100% of the cost of their medication.

TRICARE Pharmacy Home Delivery is a safe, convenient and low cost option to obtain maintenance medications. You can receive up to a 90-day supply, as opposed to a 30-day supply from a retail pharmacy, and offers a $176 savings per year on your copayments for every brand name medication you switch to Home Delivery.

A military pharmacy is a great way to fill maintenance medications, since you can receive up to a 90-day supply, and there is no cost for TRICARE beneficiaries.

Please call the Laughlin pharmacy at 830-298-6451 to see if your prescription is available. Please direct any questions concerning the new program to one of the Laughlin pharmacy representatives or a TRICARE representative (1-877-363-1303) to explain how the changes may affect you. 

For more information about the change to TRICARE's pharmacy benefit, visit www.tricare.mil/RxNewRules.