The Department of Defense announced today that on June 1, 2004, the new Tricare Retail Pharmacy (TRRx) contract takes effect for Tricare beneficiaries located in the 50 United States, the District of Columbia, Puerto Rico, the U.S. Virgin Islands and Guam. The contract, awarded last year to Express Scripts Inc. of Maryland Heights, Mo., has approximately 53,000 civilian pharmacies in the nationwide network. Express Scripts operates theTRICARE retail pharmacy for all beneficiaries, except those enrolled in the Uniformed Services Family Health Plan administered by the Designated Providers.
In the past, the Tricare regional managed care support contractors provided retail pharmacy services and most beneficiaries should not notice the change in services with the new contract. To use the new retail pharmacy program, as with all other DoD health programs, beneficiaries must be eligible and enrolled in the Defense Enrollment Eligibility Reporting System or DEERS.
The new single contract integrates the previous regional contracts into one uniform retail pharmacy benefit across all Tricare regions, said Army Col. William Davies, director, DoD pharmacy programs.
The TRRx program has many new enhancements. Pharmacy claims processing is now centralized and beneficiaries no longer have to mail pharmacy claims to multiple sites for processing or call various telephone numbers to get assistance filling a prescription when using the retail network. Patient safety has also been enhanced by use of the Pharmacy Data Transaction Service to process all pharmacy claims, including paper claims.
For a single co-payment of $3 for generic or $9 for a brand-name prescription, eligible TRRx beneficiaries may continue to receive a 30-day supply of their prescription medication from the new network of retail pharmacies. To use this benefit, a written pharmacy prescription and a uniformed services identification card are required. Tricare beneficiaries who used a retail pharmacy last year will receive, by mail, a pharmacy identification card, a TRRx benefit guide and a letter listing the twelve network pharmacies close to their home.
The TRRx benefit is now portable. Beneficiaries traveling outside of their designated Tricare region who need to fill a prescription are no longer required to pay the full prescription price, or file a Tricare claim to get reimbursed for their out-of-pocket expenses when they use a Tricare retail network pharmacy. Pharmacy co-payments are the same in every location where the TRRx is available.
To locate a network pharmacy, beneficiaries may use the Tricare pharmacy locator service available on the Express Scripts Web site at http://www.express-scripts.com/TRICARE, or they may call (866) 363-8779 or, using the letters on the telephone keypad, spell (866) DoD-TRRx.
For eligible beneficiaries with other health insurance (OHI), Tricare pays after all other insurance plans have paid. To use Tricare as the secondary payer or to obtain reimbursement for their out-of pocket pharmacy expenses, beneficiaries will need to submit a Tricare claim form (DD Form 2642) and a receipt for their prescription medication to Express Scripts for processing. If the medication under the beneficiarys OHI is not a covered benefit or if the beneficiarys prescription coverage has ended for the year, Tricare will pay as the primary insurance payer.
The TRRx benefit is not available for beneficiaries who reside or travel outside the U.S. or its territories. These beneficiaries are encouraged to use a military treatment facility, if available, or the Tricare Mail Order Pharmacy program to fill their prescription medications. Express Scripts can mail prescription medications to any U.S. postal address or to an APO/FPO address. However, Express Scripts cannot send prescriptions to a private, foreign address. Prescriptions mailed to beneficiaries in overseas locations must be prescribed by providers who are licensed to practice in the United States.
A downloadable Tricare claim form is available on the Express Scripts Web site at http://www.express-scripts.com/TRICARE or on the Tricare Web site at http://www.tricare.osd.mil/claims. Pharmacy claims filed with Express Scripts should be mailed to: Express Scripts, P. O. Box 66518, St. Louis, Mo., 63166-6518.
Beneficiaries residing in overseas locations, other than Puerto Rico, Guam and the U.S. Virgin Island, do not have access to Tricare retail pharmacy networks. Therefore, they must pay for their prescription medications upfront and submit a claim with Tricare overseas claims processor to be reimbursed. For reimbursement rates or assistance processing a non-network overseas retail pharmacy claim, beneficiaries may contact the overseas Tricare Service Center at http://www.tricare.osd.mil/overseas/index.cfm .