Falls Church, VA, June 2, 2022 - Do you have other pharmacy coverage in addition to the TRICARE Pharmacy Program? Maybe you have coverage through your employer or a private plan that you’ve purchased. TRICARE calls this other health insurance (OHI). Some OHI includes a prescription drug benefit that can be used with TRICARE. Learning more about OHI and TRICARE pharmacy benefits can save you time and money.
“If your OHI includes a prescription plan, there are several important things to know about how the two plans work together,” said U.S. Public Health Service Cmdr. Teisha Robertson, a pharmacist with the Defense Health Agency’s Pharmacy Operations Division. “Making the right choices with OHI and your TRICARE pharmacy benefit can help you pay lower costs, both up front and in total.”
How to report your OHI
It’s important that you share other health insurance you carry in addition to TRICARE with the pharmacy contractor, Express Scripts. If you don’t disclose this information, you may experience delays or problems when processing your prescription claims. To avoid these issues, tell Express Scripts you have OHI with pharmacy benefits. Complete a TRICARE Other Health Insurance (OHI) Form and mail it to Express Scripts. You may need to reach out to your other insurance company to get some required information to fill out the form.
Do you have a supplemental or discount prescription drug program? These don’t count as OHI pharmacy coverage. If you don’t know if you have OHI, you can review examples of types of coverage on the Express Scripts website.
How to lower your costs when you have OHI
If you have OHI, it doesn’t prevent you from using your TRICARE pharmacy benefit. When you have OHI with pharmacy benefits, your OHI pays first and TRICARE pays second. You can avoid higher costs by getting your prescriptions filled at a pharmacy located in both your OHI network and the TRICARE retail network.
When you fill a prescription at a network pharmacy, tell your pharmacist you have TRICARE coverage in addition to your OHI. Your pharmacist can electronically submit your prescription to both plans at the same time. Letting your pharmacist know you have two prescription plans means:
Minimal out-of-pocket expenses for you
Never paying more than the TRICARE copayment
No need to submit paper claims
Reduced or eliminated up-front costs
How to get reimbursem*nt for prescriptions
You can file a claim with TRICARE for reimbursem*nt if you meet one of the following requirements:
The pharmacy in your OHI network isn’t a TRICARE retail network pharmacy
You’ve exceeded the dollar limit for your OHI
The drug isn’t covered by your OHI
To file a claim, fill out thePatient’s Request for Medical Paymentform (DD Form 2642).And mail the form, along with your OHI explanation of benefits and your pharmacy receipt to Express Scripts. You must file your claim with TRICARE within one yearfrom the date your prescription was filled. Remember to keep your receipts. You must also print your OHI explanation of benefits. An explanation of benefits is an itemized statement that shows what action your insurance provider has taken on your claims. Submit your receipts and your OHI explanation of benefits together for reimbursem*nt.
How to use TRICARE Pharmacy Home Delivery with OHI
As outlined in the TRICARE Pharmacy Program Handbook, you aren’t eligible to use TRICARE Pharmacy Home Delivery if you have OHI with a prescription plan. This includes the Medicare Part D prescription program. There are some exceptions, however.
You can use home delivery if you meet one of the following requirements:
You have a supplemental pharmacy benefit, which is managed by Express Scripts
Your OHI doesn’t include pharmacy benefits
The drug you need isn’t covered by your OHI
You’ve met your OHI’s benefit cap (for example, you’ve met your benefit’s maximum coverage limit)
Once you’ve met one of these requirements, you may submit your prescription to TRICARE Pharmacy Home Delivery. If your drug isn’t covered or if you’ve met the OHI benefit cap, you must also include your OHI explanation of benefits. If you have a supplemental pharmacy benefit managed by Express Scripts, your benefits are automatically coordinated using both your OHI and TRICARE. This means you don’t have to file a paper claim to coordinate your OHI and TRICARE pharmacy coverage. Review details on how to get started with home delivery.
Download the TRICARE Pharmacy Program Handbook for more information about OHI and your pharmacy benefits. You can also reach out to Express Scripts. Representatives are available 24/7 to answer your questions.
FAQs
When filling your prescription at a retail network pharmacy, tell your pharmacist you have TRICARE coverage in addition to your OHI. Ask your pharmacist to submit your prescription to both insurance plans at the same time.
Can you use TRICARE and another insurance? ›
Active Duty Service Members
TRICARE is the primary payer and coordination of benefits with other insurance carriers does not occur. Active duty service members who have other health insurance (OHI) require an approval from Health Net Federal Service, LLC (HNFS) for all services.
How to use TRICARE at a pharmacy? ›
Getting Your Medication
Visit tricare.mil/mtf to find a military hospital or clinic near you. When you have a prescription filled at a participating pharmacy, present your military ID card to the pharmacist. They will verify your coverage and prescription cost.
Can I use CVS pharmacy with TRICARE? ›
CVS® now accepts TRICARE, just one more way we care for the military and veteran community.
Why are pharmacies no longer accepting TRICARE? ›
As of Oct. 24, there were 14,963 independent pharmacies that left the Tricare retail pharmacy network — primarily due to their objections about low reimbursem*nt rates — out of 55,586 retail pharmacies in the network. The loss affects an estimated 400,000 Tricare beneficiaries.
Why are doctors dropping TRICARE? ›
The problem stems from the fact that most Tricare managed care support contractors have negotiated physician reimbursem*nt rates that are even lower than those paid by Medicare. Unhappy with their fees, some major health care provider groups have simply dropped out of the system.
Can you have TRICARE and a high deductible health plan? ›
All plans under TRICARE (Standard, Extra, Prime, etc.) have been deemed by the IRS to not be qualified HDHPs. If you take Engility's CDHP as your primary coverage and also have coverage under TRICARE, you won't be able to make contributions to or receive contributions in an HSA.
Can I use Walgreens pharmacy with TRICARE? ›
Yes. To find other network pharmacies visit the Find a Pharmacy page.
Why isn't TRICARE covering my prescriptions? ›
Non-covered drugs. TRICARE doesn't cover these. They may be drugs used to treat a non-covered condition, drugs used for cosmetic purposes, multivitamins, or other products the Food and Drug Administration doesn't consider to be clinically effective.
Do you have to use Express Scripts if you have TRICARE? ›
You have the same coverage, regardless of your TRICARE health plan. However, if you use the US Family Health Plan, you have separate pharmacy coverage. Express Scripts is the contractor for the TRICARE Pharmacy Program. Express Scripts manages your home delivery and retail pharmacy services.
TRICARE's prescriptions are managed through the pharmacy contractor, Express Scripts.
Does Walmart pharmacy take TRICARE insurance? ›
No. Walmart and Sam's Club left the network on December 15, 2021. Kroger pharmacies, including Harris Teeter, Fred Meyer, Smith's Food and Drug, Fry's Food and Drug, and King Soopers, left the network on December 31, 2022. If you fill your prescriptions at any of these pharmacies, you'll pay non-network copayments.
What does TRICARE not cover? ›
In general, TRICARE excludes services and supplies that are not medically or psychologically necessary for the diagnosis or treatment of a covered illness (including mental disorder), injury, or for the diagnosis and treatment of pregnancy or well-child care.
What are the changes in TRICARE pharmacy in 2024? ›
TRICARE retail network pharmacies (Up to a 30-day supply)
Generic formulary drugs will increase from $14 to $16. Brand-name formulary drugs will increase from $38 to $43.
Why is Walmart no longer a TRICARE pharmacy? ›
After three years, Walmart is leaving Tricare's pharmacy network -- a departure that pharmacy benefit manager Express Scripts says is a result of the retail giant's reluctance to offer "more highly competitive discounts" to military health beneficiaries.
Are prescriptions free with TRICARE? ›
Active duty service members pay nothing for covered prescriptions from military pharmacies, home delivery, or retail network pharmacies. For all other beneficiaries, pharmacy costs are based on who you are, the prescription drug category, and where you fill your presciption.
Can you have TRICARE and an Advantage plan? ›
Will I lose my TRICARE For Life benefits if I sign up for a Medicare Advantage plan? No. Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are an “all in one” alternative to Original Medicare. Private companies approved by Medicare offer these plans.
Can you have both TRICARE and VA benefits? ›
If you have other forms of health care coverage (like a private insurance plan, Medicare, Medicaid, or TRICARE), you can use VA health care benefits along with these plans. Learn more about how VA works with other health insurance.
Will TRICARE pay my primary insurance deductible? ›
If you're in a plan with a deductible, you must pay your annual deductible before TRICARE begins to pay for your health care services and your prescription drugs. Active duty service members don't have an annual deductible.
What is dual eligibility for TRICARE? ›
If retiring, the service member is eligible for TRICARE as a military retiree and may also be eligible for certain VA benefits. Service members who separate due to a service-connected disease or disability may be eligible for VA benefits and certain TRICARE benefits.
