JOINT BASE CHARLESTON, S.C. –
A new program called the Pilot will require TRICARE for Life beneficiaries to use TRICARE Pharmacy Home Delivery or a military pharmacy to fill prescriptions for select maintenance medications. This Pilot, which began March 14, 2014, is a provision of the 2013 National Defense Authorization Act.
The program only applies to TFL beneficiaries who fill select "maintenance" medications at a retail pharmacy. Maintenance medications are those for chronic, long-term conditions taken on a regular, recurring basis. This does not include medications taken for a sudden illness or infection such as antibiotics or medications taken for an acute condition such as short term pain relief.
TFL beneficiaries taking an affected medication began receiving letters notifying them of the Pilot Feb. 18, 2014. Beneficiaries now have two 30-day refills of their prescriptions covered at a retail pharmacy before they are responsible for 100 percent of the cost. Beneficiaries may call the TRICARE pharmacy contractor, Express Scripts, at 1-877-882-3335 with questions about their medications or to switch to the home delivery plan.
"Home Delivery is an excellent choice for TRICARE beneficiaries to get their maintenance medications," said Col. Judith Hughes, 628th Medical Group commanding officer. "Not only is it a less expensive and convenient choice, but Home Delivery contributes to enhanced health care delivery by having your medication mailed directly to your home, so there is no need to make special trips to a pharmacy, and the automatic refill capability helps ensure you don't run out of your medication unexpectedly."
TRICARE Pharmacy Home Delivery is safe, convenient and easy to use. Home Delivery offers beneficiaries a 90-day supply of their brand-name medication for $13. Switching these prescriptions from a retail pharmacy to Home Delivery can save TRICARE beneficiaries up to $152 a year for each prescription. Beneficiaries can also save by asking their doctor to write them a prescription for a generic version of their medication.
Under the Pilot, you will need to choose one of several options for these maintenance medications:
Option 1: Transfer your medication from a retail pharmacy to safe, convenient TRICARE Home Delivery and pay less money out-of-pocket. A typical cost for a 90-day retail supply is $51 but only $13 for Home Delivery.
Option 2: Ask your doctor about using a low-cost generic that is not among the medications included in the Pilot. Generics not included in the program can still be filled at a retail pharmacy for $5.
Option 3: Transfer maintenance medications from a retail pharmacy to a military pharmacy. Call your local military pharmacy to verify they have your medication.
Option 4: Continue to get your selected maintenance medications at a retail pharmacy and pay 100% of the cost of the medication starting with your second refill.
If you refill your selected maintenance medications at a retail pharmacy after March 14, 2014, you'll get letters from the TRICARE Pharmacy contractor, Express Scripts, Inc., about switching to Home Delivery. Remember, starting with your third refill you will be responsible for 100% of the cost of the medications if you choose to continue to obtain them at a retail pharmacy.
If you have other health insurance with a prescription benefit, you do not fall under the Pilot. There will also be a process to obtain waivers on a case-by-case basis, due to personal need, hardship, emergency, or other special circumstances - such as living in a nursing home. After participating in the Pilot for one year, you may opt-out.
For the most recent information about the Pilot program, to sign up for e-alerts with the latest updates, or to request a waiver go to www.tricare.mil/tflpilot
If you decide to convert your maintenance medication prescription to the pharmacy at the 628th Medical Group, please call ahead at 963-6833, option 7 to make sure your prescription is available.
If you decide to convert your maintenance medication prescription to the Naval Health Clinic Pharmacy, call 794-6120.