by Nancy Martin
20th Medical Group Contract Liaison Officer
2/4/2013 - SHAW AIR FORCE BASE, S.C. -- Users of the military health care system, TRICARE, face new co-payments as of last week, TRICARE officials have announced.
Changes apply to all TRICARE programs except when you fill prescriptions at a non-network pharmacy. Changes include:
· The co-pay for generic medications will remain at $5 for a 30-day prescription filled at a network pharmacy.
· There is no co-pay when generic prescriptions are filled through TRICARE Home Delivery.
· The new co-pay for a 30-day supply of a brand name medication purchased at a retail network pharmacy will be $17, up from the current $12.
· Beneficiaries using home delivery will pay $13 for brand-name drugs, up from $9. However, the home delivery price covers a 90-day supply instead of a one-month supply.
· If prescriptions are purchased at a non-network pharmacy, a point-of-service fee will apply to TRICARE Prime patients.
TRICARE Standard and Extra beneficiaries will pay a percentage based on their annual deductible obligations.
The greatest change in co-pays applies to non-formulary medications, meaning drugs not on the local TRICARE list. The $25 co-pay for these drugs increases to $44 at retail pharmacies and $43 through home delivery, unless medical necessity is established. However, if you can prove medical necessity, then formulary costs will apply.
You can learn more about medications, download forms and obtain further instructions or review drugs included on the TRICARE formulary by visiting the Department of Defense Pharmaco-economic Center website at http://pec.ha.osd.mil/forms_criteria.php.
Pharmacies at military hospitals and clinics, including here, will continue to provide medications with no co-pays. You can also register for the home delivery program at www.express-scripts.com/TRICARE for lower cost options than retail pharmacies.
Visit www.TRICARE.mil/pharmacycosts to learn more about your TRICARE pharmacy benefit or visit the 20th Medical Group TRICARE service center, from 7:30 a.m. to 4:30 p.m., Monday through Friday, building 453, to speak with a beneficiary services representative.
