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NEW TRICARE PRESCRIPTION COSTS
On October 1, 2011, generic medications changed to zero copayment when filled through home delivery while retail pharmacy costs were raised.
The following changes to the TRICARE pharmacy copayments went into effect Oct. 1:
• Generic formulary drugs purchased at retail pharmacies will go from $3 to $5.Brand name formulary drugs purchased through Home Delivery have the same $9 copayment. Copayments for prescriptions filled through Home Delivery cover a 90-day supply, but only a 30-day supply when purchased at a retail pharmacy.
• Brand name formulary drugs from retail pharmacies will go from $9 to $12.
• Non-formulary medications will go from $22 to $25 in both retail and Home Delivery.
“This is the first change to TRICARE pharmacy copays since 2002." a TRICARE official said. For more details visit the "COST" page on the TRICARE web site.
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NEW TRICARE STANDARD HANDBOOK RELEASED
TRICARE is making a handbook available to all beneficiaries covered under TRICARE Standard. This new manual goes into much greater detail than the old booklet, making it as useful as the TRICARE Prime and Prime Remote handbooks. You can obtain a copy in PDF by going to their web page as well as dowloading other TRICARE Handbooks. Click here to view the new STANDARD HANDBOOK.
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ATTENTION: TRICARE-eligible and Medicare-eligible Beneficiaries Under Age 65
TRICARE-eligible and Medicare-eligible beneficiaries under age 65 should receive a letter in the mail from DEERS.
Beneficiaries under age 65, except the family members of active duty servicemembers, who are entitled to Medicare Part A because of disability or end-stage renal disease must purchase Medicare Part B. Please note that family members of active duty servicemembers who are eligible for Medicare retain eligibility for TRICARE Prime, Standard, and Extra whether they purchase Medicare Part B or not. However, purchase is recommended.
Medicare and TRICARE now are able to exchange data on beneficiaries that become Medicare eligible. If applicable, Medicare Part B enrollment now will be maintained on DEERS records. Recently, DEERS started mailing letters to this group of beneficiaries explaining the requirement to purchase Medicare Part B in order to remain entitled to TRICARE benefits.
Additionally, if a beneficiary stops paying Part B premiums, they will become ineligible for TRICARE. That means that no future claims will be paid by TRICARE, and recoupment action could be initiated to recover payments made for any ineligible period of time.
For questions about TRICARE and Medicare coordination, call 1-866-773-0404.
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TRICARE PROVIDER CATEGORIES
(Reprinted from Hanscom Air Force Base
"Military Retirees Newsletter" - Summer 2005)
For those under age 65 that use TRICARE, Prime, Standard or Extra there continues to be confusion about what it means when a provider “takes” TRICARE. The question to ask a provider is if he/she is an “authorized” (non-network) provider, or a “participating” (network) provider. The difference is as follows.
AUTHORIZED OR NON-NETWORK PROVIDER is one who has submitted his/her credentials to TRICARE including appropriate state licensing and certification documents and personal information to meet state and federal billing and tax requirements. (As of 1 September 2004, all Medicare approved providers are accepted as TRICARE authorized). They are permitted to charge 15% above the TRICARE approved amount the beneficiary will be responsible for. Non-network providers may or may not submit the claim, which is paid under TRICARE Standard. TRICARE cannot pay for services from an unauthorized provider.
PARTICIPATING OR NETWORK PROVIDER is an authorized provider who has signed an agreement with the TRICARE contractor to accept a negotiated rate as payment in full (plus your cost share) and to file claims for services paid under TRICARE Extra.
The relative availability of “network” versus “non-network” providers will vary significantly from place to place. Assistance with finding a provider can be obtained at a TRICARE Service Center (TSC) or at www.tricare.osd.mil. For the North region, www.healthnetfederalservices.com. Since Medicare is the primary payer for those with TFL, these categories do not apply. You may go to any provider that accepts Medicare.
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TRICARE RESOURCES
(Reprinted from Hanscom Air Force Base
"Military Retirees Newsletter" - Summer 2005)
For questions, or change of address for TRICARE Prime, Standard, or Extra call 1-877-874-2273 (1-877-TRICARE) – or on-line at www.healthnetfederalservices.com. Claims should be submitted to: Health Net Federal Services Inc., c/o PGBA LLC/TRICARE Claims, PO Box 870140, Surfside SC 29587-9740. To get TRICARE answers, or assistance by email send to TRICARE_Help@AMEDD.ARMY.MIL or QUESTIONS@tma.osd.mil.
For questions, or to update health insurance information for TRICARE For Life (TFL), call Wisconsin Physicians Services (WPS) at 1-866-773-0404, or visit www.tricare4u.com. Claims should be submitted to Wisconsin Physicians Services/TRICARE For Life, PO Box 7890, Madison WI 53707-7890.
Express Scripts is the contractor for both the Mail Order and Retail Pharmacy Programs
TRICARE Mail Order Pharmacy (TMOP) call – 1-866-363-8667 – www.express-scripts.comTRICARE Retiree Dental Plan call-1-888-838-8737 – www.ddpdelta.org/
TRICARE Retail Pharmacy (TRRx) call1-866-363-8779 – www.express-scripts.com
Claims for pharmacy, send to: Express Scripts Inc., PO Box 66518, St Louis MO 63166-6518
DEERS Address Change - 1-800-538-9552 – www.tricare.osd.mil/DEERSAddress/
US Family Health Plan – Brighton Marine Health Center at 1-888-815-5510
US Family Health Plan – Martin’s Point (NH, ME) 1-888-241-4456, or visit www.martinspoint.org
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THIRD Rx TIER
DoD establishes medical necessity criteria for each non-formulary medication, placing certain medications on the third tier (more expensive) “non-formulary” category, requiring a $22 copayment. You can check out a chart of third tier drugs at the TRICARE Pharmacy web site.
The $22 copay will buy a 30-day supply from a TRICARE Retail Pharmacy (TRRx) or a 90-day supply from the TRICARE Mail Order Pharmacy (TMOP). A non-network pharmacy will require a payment of $22 or 20 percent of the price of the medication, whichever is higher.
Third tier drugs with a $22 copay will not be stocked in Military Treatment Facility (MTF) pharmacies but will be special-ordered if an MTF physician determines these drugs are medically necessary for a specific patient.
Beneficiaries or providers who have questions or concerns regarding these or other medications can call Express Scripts at 1-877-363-1303, or visit their website at http://www.express-scripts.com/TRICARE/. For questions about TMOP, visit http://tricare.mil/mybenefit/home/Prescriptions/FillingPrescriptions/TMOP. The Formulary Search Tool also can provide additional information about medications, their availability, and cost at: http://pec.ha.osd.mil/formulary_search.php#.
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An Important Message about TRICARE and Medicare
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Similar Names - Different Benefits
TRICARE, Medicare, skilled nursing facility care and long-term care. Each has the word "care" in its name, but is in itself a totally unique health care benefit. So what are skilled nursing facility care and long-term care? Are either covered benefits under Medicare or TRICARE? What about TRICARE For Life (TFL)? Does this mean TRICARE pays all health care expenses for eligible beneficiaries? If you are a Uniformed Services beneficiary, family member, survivor, or provider, you need to know the difference. For details about each of these, use the following link: www.tricare.osd.mil/news/2003/news0322.cfm.
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TRICARE Senior Pharmacy (TSRx) and TRICARE for Life (TFL)
Almost 4,500 Medicare eligible New Hampshireites who are military retirees and enrolled in Medicare Part B can participate in two new medical programs, “TRICARE Senior Pharmacy” (TSRx) and “TRICARE for Life” (TFL), if they are in the DEERS (Defense Eligibility Enrollment Reporting System) database. This includes their spouses and survivors, if also enrolled in Medicare Part B and DEERS. Both programs are in addition to existing pharmacy and medical benefits offered on a space-available basis at many military installations.
TRICARE Senior Pharmacy retail and mail order service began April 1, 2001. Under the retail program, beneficiaries can fill most 30-day prescriptions at participating pharmacies at a cost of $3.00 for generic drugs and $9.00 for name brands. Costs will be higher at non-participating pharmacies. Using the National Mail Order Pharmacy, a 90-day prescription costs $3.00 for generic drugs and $9.00 for name brands.
TRICARE for Life began on October 1, 2001. TRICARE became the secondary payer to Medicare for Medicare-authorized services from civilian providers. Beneficiaries pay no annual enrollment fee, premium or deductible, so this program virtually eliminates the need for Medicare supplemental insurance.
Many beneficiaries in retirement homes, assisted living facilities and nursing homes, as well as others who are not active with retired military or veterans’ organizations, do not know about these new programs. In order to assist them, the New Hampshire Chapter of MOAA has established a point of contact for anybody, regardless of service rank, who has questions about TSRx and TFL. Email Joan Huber at joanhuber@aol.com.
Enrollment in TSRx and TFL
No enrollment is necessary. All that is required is a Medicare card (showing Part B participation) and a valid military ID card. For the ID card to be valid, the beneficiary's current family and address information must be registered in the DEERS (Defense Eligibility Enrollment Reporting System) database. DEERS registration can be accomplished at most armed forces military installations, and normally is verified each time an individual gets a new military ID card.
- TSRx:
To find local participating pharmacies (most national chains
participate): 1-877-363-6337
Formulary: www.pec.ha.osd.mil/ac01001.htm
Mail Orders: 800-903-4680; or www.express-scripts.com
- DEERS (Defense Eligibility Reporting System) and ID Card Issuance
To register in DEERS, the beneficiary needs a current military
ID card, which can be obtained or applied for while registering. The sponsor
normally must be present to register family members, and will need to bring
a copy of the marriage certificate for first-time registration. Surviving
spouses who do not already have a military ID card should bring a current
photo identification and a copy of the marriage certificate, along with
the sponsor's DD Form 214 (Report of Separation From Active Duty), and
a death certificate.
To update DEERS Information
1. Contact a nearby military personnel office; or
2. E-mail changes to addrinfo@osd.pentagon.mil;
or
3. Mail changes to DEERS Support Office, Attn: COA, 400 Gigling
Road, Seaside, CA 93955-6771; or
4. Visit https://www.tricare.osd.mil/DEERSAddress/;
or
5. Call 1-800-538-9552
- Medicare Part B Participation
Medicare-eligibles not currently covered by Part B can sign up
for it during the next General Enrollment Period which runs from January
1 through March 31. For more information about Part B, contact a local
Social Security office or call Social Security toll free at 1-800-772-1213.
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