By Dana Bretz
Are you aware of the change affecting TRICARE beneficiaries? Chances are you may have heard about it, but do you know what it means for you? It’s important that military spouses be as educated as possible when it comes to benefit changes, especially ones that can cause quite the headache if we’ve somehow missed them! So let’s get educated.
Starting October 1st, all TRICARE beneficiaries, excluding active duty and those living overseas, will be required to get select brand name maintenance drugs through either TRICARE Pharmacy Home Delivery or from a military pharmacy.
What is a maintenance drug? A maintenance drug is a medication that you take regularly for extended periods of time. An example would be if you are diabetic and take a long term medication to manage diabetes. That medication would be considered a maintenance drug. You might have received a letter from Express Scripts, the TRICARE pharmacy contractor, regarding your options if you are taking an affected drug. If you have questions concerning whether or not your particular maintenance drug will be covered, call Express Scripts at 1-800-363-1303. You can also view a list of drugs that will no longer be covered at retail pharmacies at http://www.health.mil/selectdruglist.
If you choose to fill an affected prescription at a pharmacy after October 1, you will receive a final notice from Express Scripts and one last curtesy refill at a retail pharmacy. However, if you continue using a retail pharmacy after the allowed one time curtesy refill, you will be responsible for 100 percent of the medications cost.
The new law that requires these changes will not affect short term prescriptions, meaning if you are prescribed a pain medication or antibiotic temporarily, you may still be able to use a network retail pharmacy.
Now, you do still have options. If your brand name medication is one that will no longer be covered, you can consider using a generic brand substitute if it’s available. Generic brands will still be covered and refillable at network pharmacies. There are also certain situations that may be eligible for a waiver, and will be specific to a beneficiary’s personal need. These will all be case by case and you will need to contact Express Scripts.
For all others that will need to switch to Home Delivery you can start by visiting https://www.express-scripts.com/TRICARE/index.shtml or calling the Express Scripts Member Choice at 1-877-882-3335. Your provider can also fax your prescription to 1-877-895-1900. If Home Delivery isn’t something you’re interested in you will need to contact your military pharmacy to see if the prescription you need is on their formulary and request a transfer.
Embrace the change and spread the word, because it won’t be the last. Tis the life of a military spouse!