The new Tricare Senior Pharmacy Program officially begins operation on April 1 for an estimated 1.4 million potentially eligible uniformed Services beneficiaries age 65 years and older. The Tricare Senior Pharmacy Program is a comprehensive drug benefit not provided under traditional Medicare.
"This new pharmacy benefit will greatly assist our beneficiaries by standardizing copayments and lowering the cost of generic medications. Our senior beneficiaries will benefit from this program by having access to medications with lower out-of-pocket expenses," said Acting Assistant Secretary of Defense for Health Affairs Dr. J. Jarrett Clinton.
By law, to use the Tricare retail and mail order benefit, beneficiaries age 65 and over must be eligible for Medicare Part A and enrolled in Part B. (Exception: Those who turned 65 before April 1, 2001, are eligible for the benefit, even if they are not enrolled in Medicare Part B.) For more information on enrollment requirements for Medicare Part B, the toll-free number for Medicare is (800) MEDICARE or (800) 633-4227.
Beneficiaries also must be registered in the Defense Enrollment Eligibility Reporting System (DEERS). Beneficiaries who are unsure about their DEERS enrollment status or eligibility for this program may contact the toll-free Defense Manpower Data Center Support Office Beneficiary Line at (800) 538-9552 for assistance. The call center is open weekdays (Monday through Friday) from 6 a.m.-3:30 p.m. Pacific Time.
Pharmacy Copayments Simplified
At the same time, DoD is also simplifying the prescription copayments for all DoD beneficiaries, reducing the different copayment possibilities from about 30 to three.
The new Tricare pharmacy benefit offers a straightforward co-payment structure and the following four dispensing options listed in order of cost/value to the beneficiary:
Military Treatment Facility Pharmacy. Military treatment facility (MTF) pharmacies will continue to fill prescriptions written by either military or civilian prescribers for medications listed on the MTF's formulary. There is no co-payment or out-of-pocket expense for prescriptions filled at the MTF.
National Mail Order Pharmacy (NMOP). Prescriptions filled through the NMOP will be $3 for up to a 90-day supply of most generic medications, or $9 for up to a 90-day supply of most non-generic medications.
Retail Network Pharmacy. Prescriptions filled at a retail network pharmacy will be $3 for a 30-day supply of most generic medications or $9 for a 30-day supply of most non-generic medications.
Retail Non-network Pharmacy. At non-network pharmacies, beneficiaries will pay either $9 or 20 percent of the total cost (whichever is greater), for a 30-day supply of a medication after they have met the Tricare annual deductible ($150 per individual or $300 per family). Both deductibles and co-payments are applied toward the beneficiary's Tricare catastrophic cap.
To use the retail pharmacy benefit beneficiaries should show the pharmacy a current Uniformed Services Identification (ID) card. To update an outdated ID card beneficiaries may call toll-free (877) DOD-MEDS or (877) 363-6337 to locate the closest military ID card issuing activity. The call center is open weekdays (Monday through Friday) from 7 a.m.-11 p.m. Eastern Time.
In February and March, Tricare's regional contractors sent a mailing to Medicare-eligible military beneficiaries worldwide. The mailing included a Tricare Senior Pharmacy Program brochure, local pharmacy directories, NMOP brochures and NMOP registration forms. For more information on the Tricare Senior Pharmacy Program, see the Military Health System/Tricare Web site at http://www.tricare.osd.mil/pharmacy/ .