You can find out if your medication is covered by looking it up on the Formulary Search Tool.

Your provider can call the Express-Scripts Prior Authorization line @ 1-866-684-4488 to request a medical necessity override. 

NOTE: In some cases your medication (injections and vaccines) may be covered as a medical benefit so you can call your TRICARE Regional Contractor.

You can contact Express-Scripts Customer Service @ 1-877-363-1303 for information regarding the appeals process.

You can find out if generic is required by looking it up on the Formulary Search Tool.

Your provider can either call the Express-Scripts prior authorization line @ 1-866-684-4488 to establish medical necessity or he/she can fill out the Brand over Generic Prior Authorization Request Form and fax it to Express-Scripts.

You can contact Express-Scripts Customer Service @ 1-877-363-1303 for information regarding the appeals process.

You can find out if your medication requires prior authorization by looking it up on the Formulary Search Tool.

Your provider can either call the Express-Scripts prior authorization line @ 1-866-684-4488 or he/she can fill out the prior auth form that is linked to that medication on the Formulary Search Tool and fax it to Express-Scripts.

You can contact Express-Scripts Customer Service @ 1-877-363-1303 for information regarding the appeals process.

You can find out if your medication requires medical necessity by looking it up on the Formulary Search Tool.

Your provider can either call the Express-Scripts prior authorization line @ 1-866-684-4488 to establish medical necessity or he/she can fill out the medical necessity form that is linked to that medication on the Formulary Search Tool and fax it to Express-Scripts.

You can contact Express-Scripts Customer Service @ 1-877-363-1303 for information regarding the appeals process.

You can look up your medication on the Formulary Search Tool. These will be listed under the "Notes" section.

Your provider will need to call the Express-Scripts Prior Authorization line @ 1-866-684-4488 to establish medical necessity.

You can contact Express-Scripts Customer Service @ 1-877-363-1303 for information regarding the appeals process.

You can find out if there are quantity limits on your medication is covered by looking it up on the Formulary Search Tool. These will be listed under the "Notes" section.

Your provider can call the Express-Scripts PA line @ 1-866-684-4488 to establish medical necessity for a quantity limit override.

You can contact Express-Scripts Customer Service @ 1-877-363-1303 for information regarding the appeals process.

You can contact Express-Scripts Customer Service @ 1-877-363-1303 for assistance.

The following websites have medication information like indications and side effects: 

• www.drugs.com
• www.rxlist.com
• www.webmd.com

We want to evaluate the collaboration between our MTFs, the regional contractors and civilian emergency departments. The outcome may enable us to consider operational and financial changes needed to:

• Optimize the capabilities of the direct care system
• Support medical readiness
• Enhance MTF provider efficiency and graduate medical education programs
• Steward taxpayer dollars
• Reduce beneficiary costs
• Enhance beneficiary satisfaction

Beneficiaries will need to decide based on their individual scenario. They may already have a doctor at the MTF they prefer to see or maybe they are using TRICARE Standard and Extra and moving to an MTF will save them money.

A transfer won’t be recommended unless the patient is clinically stable and doctors at both facilities agree to the transfer. Ultimately, it’s a personal decision, and beneficiaries should consider:

• The rules for their health plan (i.e. TRICARE Prime, TRICARE Standard, TRICARE For Life)
• The type of care they need and how long they may be admitted
• Which facility is more convenient for them (closer to home, etc.)
• Costs for the care at a civilian facility compared to the MTF

Each MTF will establish its own process, but basically:

• The civilian facility will contact the MTF Patient Transfer Hotline
• The MTF decides if they will accept the transfer within 30 minutes
• Patient transport is arranged within 30 minutes

MTFs and regional contractors will work with neighboring civilian facilities to inform them about the process and provide educational materials about the pilot.

For more information, contact a participating MTF using the links listed in the chart above.

For the pilot, if either the civilian facility or the MTF makes the request, it is considered an "order" and allows TRICARE to cost share for the ambulance transport to the MTF. >>View Health Plan Costs

In some locations, the MTF may arrange for a contracted ambulance service at no cost to the beneficiary.

You should contact the payer and ask for the reason(s) that the claim was denied and what information is necessary to correct the claim (make sure you document the conversation). In addition to reviewing on a claim by claim basis, review denials for trends for certain submissions. Talk with your utilization review team to get a sense as to what is impacting covered vs. non-covered claims, identify trends, and seek to proactively reduce and correct common mistakes.

For additional questions or comments, please e-mail the UBO Help Desk, or leave a message for the Help Desk staff at 202-776-1532.

Yes, MTFs can bill for acupuncture and chiropractic services, provided there are UBO approved rates for the services (CPT or HCPCS codes). However, the payer may not cover acupuncture and chiropractic services if the payer determines those services are not covered, unless they are deemed medically appropriate by the provider. 

In 1993, Deputy Secretary of Defense William Perry issued a memorandum on "Chemical Weapons Research Programs Using Human Test Subjects." The memorandum released "any individuals who participated in testing, production, transportation or storage associated with any chemical weapons research conducted prior to 1968 from any non-disclosure restrictions or written or oral prohibitions (e.g., oaths of secrecy) that may have been placed on them concerning their possible exposure to any chemical weapons agents."

Secretary Perry also directed the Services to initiate procedures to release individuals who participated in testing, production, transportation or storage associated with any chemical weapons research after 1968 from any non-disclosure restrictions that may have been placed on them. Since most information relating to this research has been declassified, at least in part, Force Health Protection and Readiness has determined that participants in chemical-related research after 1968 may talk about their individual experiences to the Department of Defense (DoD) or the Department of Veterans Affairs without violating their oath of secrecy.

In January 2011, another memo, "Release from Secrecy Oaths Under Chem-Bio Research Programs", was released. This new memo clarifies and expands the 1993 directive to include biological weapons test subjects.

DoD maintains a Project 112/SHAD (Shipboard Hazard and Defense) database. This database contains the names of veterans who were participated in Project 112/SHAD testing in the 1960s and 1970s. It contains 6,400 names and is updated as needed when we discover additional veterans who were part of this testing. DoD also maintains a database containing the names of veterans who participated in mustard agent tests during World War II. The total numbers to date are 6,730. DoD is also currently in the process of populating our third exposure database, the Cold War Exposure database, which numbers 30,726. This database contains the names of veterans not included in other databases who participated in chemical and biological testing since World War II.

The total number for all of the databases currently is 43,856.

The Defense Threat Reduction Agency maintains information on veterans exposed to radiation during the Nuclear Test Personnel Review (NTPR) Program.

For each individual, the database will contain the following if available:

• Type of test (i.e., performance, equipment, etc.)
• Type of exposure (i.e., injection, intravenous (IV), etc.)
• Date of exposure
• Agent/simulant name
• Agent/simulant amount if recorded
• Treatments required as a result of the exposure
• Documents describing the test procedures, if available.

If you need help verifying your possible participation in any of the tests or have information about the testing, please send us an e-mail at CBWebmaster@tma.osd.mil or call the Department of Defense's (DoD) contact managers at (800) 497-6261, Monday through Friday, 7:30 a.m. to 4 p.m. EST.

Alternatively, you may write to us at:

Force Health Protection and Readiness
ATTN: CB Exposures Manager
7700 Arlington Blvd.
Falls Church, VA 22042

If you'd like to speak with a Veterans Affairs (VA) representative, call the Special Issues Helpline at (800) 749-8387. Many states offer services and benefits to veterans. To find out more about a particular state, please visit the VA State Veterans Affairs page.

The Department of Defense (DoD) has identified over 400 substances used during testing. Not all the substances were harmful as DoD tested many medicines and antidotes. These substances may be broken down as follows:

• Chemical Agents (e.g., nerve agents, irritants)
• Biological Agents (e.g., tularemia)
• Vaccines (e.g., tularemia vaccines)
• Hallucinogenic drugs (e.g., LSD)
• Antidotes (e.g., atropine)
• Medicines (e.g., Benadryl)
• Other (e.g., alcohol, saline solution)
• Tracers
• Placebos

No. Current medical chemical & biological defense programs involving human subjects do not involve the exposure of these subjects to chemical or biological warfare agents.

There are medical chemical & biological defense programs that involve the use of human subjects in controlled clinical trials to test and evaluate the safety and effectiveness, of medical products (drugs, therapies, etc.) to protect against chemical agents. The use of human subjects in these trials involves volunteers who have provided informed consent. All use of human subjects in these trials is in full compliance with the "Common Rule," Federal Policy for the Protection of Human Subjects, Food and Drug Administration (FDA) regulations, Federal Acquisition Regulations (FAR), DoD Directives and Instructions, and all other applicable laws, regulations, issuances, and requirements.

The contractor doing the research for DoD on potential exposures has over 10 years of experience working with potential exposures. This experience enabled them to quickly identify major document storage locations and to prioritize their search efforts. More important is whether or not a storage site catalogued its documents. If a storage site did not catalogue its collection, researchers must comb through all material to locate the small subset that contains exposure information. This slows down the search effort.

Before terminating our efforts to locate potential chemical and biological exposures, DoD will work with its contractor to insure that the contractor did not miss any storage site that potentially contained a significant number of exposures.

West Nile virus is an arthropod-borne virus (arbovirus) most commonly spread by infected mosquitoes.

West Nile virus is most commonly transmitted to humans by mosquitoes. Additional routes of human infection have also been documented. It is important to note that these methods of transmission represent a very small proportion of cases:

• Blood transfusions
• Organ transplants
• Exposure in a laboratory setting
• From mother to baby during pregnancy, delivery, or breastfeeding 

West Nile virus is not transmitted:

• From person-to-person or from animal-to-person through casual contact. Normal veterinary infection control precautions should be followed when caring for a horse suspected to have this or any viral infection.
• From handling live or dead infected birds. You should avoid bare-handed contact when handling any dead animal. If you are disposing of a dead bird, use gloves or double plastic bags to place the carcass in a garbage can.
• Through consuming infected birds or animals. In keeping with overall public health practice, and due to the risk of known food-borne pathogens, always follow procedures for fully cooking meat from either birds or mammals.

No symptoms in most people: Most people (70-80%) who become infected with West Nile virus do not develop any symptoms.

Febrile (fever) illness in some people: About 1 in 5 people who are infected will develop a fever with other symptoms such as headache, body aches, joint pains, vomiting, diarrhea, or rash. Most people with this type of West Nile virus disease recover completely, but fatigue and weakness can last for weeks or months.

Severe symptoms in a few people: Less than 1% of people who are infected will develop a serious neurologic illness such as encephalitis or meningitis (inflammation of the brain or surrounding tissues).

• The symptoms of neurologic illness can include headache, high fever, neck stiffness, disorientation, coma, tremors, seizures, or paralysis.
• Serious illness can occur in people of any age. However, people over 60 years of age are at the greatest risk for severe disease. People with certain medical conditions, such as cancer, diabetes, hypertension, kidney disease, and people who have received organ transplants, are also at greater risk for serious illness.
• Recovery from severe disease may take several weeks or months. Some of the neurologic effects may be permanent.
• About 10 percent of people who develop neurologic infection due to West Nile virus will die.

West Nile virus disease cases have been reported from all 48 lower states. The only states that have not reported cases are Alaska and Hawaii. Seasonal outbreaks often occur in local areas that can vary from year to year. The weather, numbers of birds that maintain the virus, numbers of mosquitoes that spread the virus, and human behavior are all factors that can influence when and where outbreaks occur.

Serious illness can occur in people of any age. However, people over 60 years of age are at the greatest risk for severe disease. People with certain medical conditions, such as cancer, diabetes, hypertension, kidney disease, and people who have received organ transplants, are also at greater risk for serious illness.

There are no medications to treat or vaccines to prevent West Nile virus infection. Over-the-counter pain relievers can be used to reduce fever and relieve some symptoms.

People with milder symptoms typically recover on their own, although some symptoms may last for several weeks.

In more severe cases, patients often need to be hospitalized to receive supportive treatment, such as intravenous fluids, pain medication, and nursing care.

The most effective way to avoid West Nile virus disease is to prevent mosquito bites:

• Use insect repellents when you go outdoors. Repellents containing DEET, picaridin, IR3535, and some oil of lemon eucalyptus and para-menthane-diol products provide longer-lasting protection.
• Wear long sleeves and pants from dusk through dawn when many mosquitoes are most active.
• Install or repair screens on windows and doors. If you have it, use your air conditioning.
• Help reduce the number of mosquitoes around your home. Empty standing water from containers such as flowerpots, gutters, buckets, pool covers, pet water dishes, discarded tires, and birdbaths.

West Nile virus disease is a nationally notifiable condition. Cases are reported to CDC by state and local health departments using standard case definitions.

The Zika virus is spread primarily through the bite of an infected mosquito. These are the same mosquitoes that spread other viruses like dengue and chikungunya. Only about one in five people infected with the Zika virus will feel sick. In those that do, symptoms are usually mild and can include fever, rash, joint pain and red eye.

Learn more about symptoms and diagnosis from the Centers for Disease Control and Prevention (CDC).

Many people infected with Zika virus won’t have symptoms or will only have mild symptoms. 

• The most common symptoms of Zika are fever, rash, joint pain, or conjunctivitis (red eyes). 
• Other common symptoms include muscle pain and headache. 
• The illness is usually mild with symptoms lasting for several days to a week.
• People usually don’t get sick enough to go to the hospital, and they very rarely die of Zika. For this reason, many people might not realize they have been infected.

The incubation period (the time from exposure to symptoms) for Zika virus disease is not known, but is likely to be a few days to a week. See your doctor or other healthcare provider if you are pregnant and develop a fever, rash, joint pain, or red eyes within 2 weeks after traveling to an area with Zika. Be sure to tell your doctor or other healthcare provider where you traveled.

Zika is primarily spread to people through the bite of infected Aedes mosquitoes. It can also be transmitted from a pregnant mother to her baby during pregnancy, though we do not know how often that transmission occurs.

Learn more about Zika transmission.

• Zika virus can be spread by a man to his sex partners.
• In known cases of sexual transmission, the men developed Zika virus symptoms. From these cases, we know the virus can be spread when the man has symptoms, before symptoms start and after symptoms resolve.
• In one case, the virus was spread a few days before symptoms developed.
• The virus is present in semen longer than in blood.

>>View the CDC's Interim Guidance for Prevention of Sexual Transmission of Zika Virus

People are contracting Zika in areas where Aedes mosquitoes are present, which include South America, Central America and the Caribbean. As the CDC notes, specific areas where the Zika virus is being transmitted are likely to change over time, so please check the CDC website for the most updated information.

Anyone who is living in or traveling to an area where the virus is found is at risk for infection.

There is no vaccine or specific medicine to treat Zika virus infections.

Treat the symptoms:

• Get plenty of rest.
• Drink fluids to prevent dehydration.
• Take medicine such as acetaminophen to reduce fever and pain.
• Do not take aspirin or other non-steroidal anti-inflammatory drugs.
• If you are taking medicine for another medical condition, talk to your healthcare provider before taking additional medication.

There may be a link between a serious birth defect called microcephaly—a condition in which a baby's head is smaller than expected—and other poor pregnancy outcomes and a Zika infection in a mother during pregnancy. While the link between Zika and these outcomes is being investigated the CDC recommends that you take special precautions if you fall into one of these groups:

If you are pregnant (in any trimester):

• You should consider postponing travel to any area where the Zika virus is active.
• If you must travel to an active region, talk to your doctor first and follow the steps to prevent mosquito bites during your trip.
• If you are trying to become pregnant:
• Before you travel, talk to your doctor about your plans to become pregnant and the risks posed from infection.

For more information, please visit the CDC's resources:

• Thinking About Pregnancy
• Pregnancy Questions & Answers
• Contraceptition to Prevent Unintended Pregnancy during the Zika Outbreak
• Contraceptive Use of Nonpregnant and Postpartum Women

Families of newborns affected by Zika virus (Zika) may be overwhelmed, worried, and unsure of next steps in caring for their baby.  A baby affected by Zika virus may be born with significant health issues, like microcephaly. Others may not have apparent symptoms at birth, but may develop them over time.

For more information, please visit the CDC web page for Families of Newborns Affected by Zika.

Right now, there is no vaccine to prevent this disease. The best way to prevent diseases by mosquitoes is to protect yourself from getting bitten. Here’s how:

• Wear long-sleeved shirts and long pants.
• Stay in places with air conditioning or that use window, door screens, and netting to keep mosquitoes outside.
• Use Environmental Protection Agency (EPA)-registered insect repellents. All EPA-registered insect repellents are evaluated for safety and effectiveness.
• Treat clothing and gear with permethrin or purchase permethrin-treated items.
• Sleep under a mosquito bed net if you are overseas or outside and are not able to protect yourself from mosquito bites.

You can get a more in-depth explanation of prevention measures from the CDC.

• The U.S. mainland does have Aedes species mosquitoes that can become infected with and spread Zika virus. 
• U.S. travelers who visit a country where Zika is found could become infected if bitten by a mosquito.
• View Zika cases reported in the United States

Florida

The Florida Department of Health has identified two areas of Miami-Dade County where Zika is being spread by mosquitoes. In addition to the previously identified area in the Wynwood neighborhood, there is now mosquito-borne spread of Zika virus in a section of Miami Beach. >>Learn More