Tricare Changes Maintenance Meds Benefit

If you take certain name brand maintenance prescriptions, a new law will change your benefit.  As of October 1, 2015, non-active duty Tricare beneficiaries who use name brand maintenance medications are required to use either the Tricare mail order pharmacy or military pharmacies for these prescriptions.  Beneficiaries who keep using a retail pharmacy for these drugs will have to pay the full cost.

Maintenance drugs are drugs you take regularly for a long time, such as to control blood pressure or cholesterol.  Under the new rules, you have two choices for filling these prescriptions:  the Tricare mail order pharmacy program, or a military pharmacy.

Tricare Mail Order Pharmacy Program

The Tricare mail order pharmacy program is a convenient and low-cost option for medications that you take regularly.  It can take a little bit of effort to get your prescriptions set up in the system, but it is super-easy once you have it going.  Plus, you’ll likely save money.  Tricare estimates that beneficiaries will save up to $176 per prescription each year.  Amy Bushatz has put together a great cheat sheet here at Mail-Order Those Drugs:  A Tricare How-To.

There are three ways to get a prescription into the Tricare mail order pharmacy system:  online, through e-prescribing, or via the regular mail.

  • You can move the prescription online at the Tricare pharmacy website.  This requires that you set up an account and take some steps to move the prescription.
  • You can also ask if your doctor uses an e-prescribing system that allows him or her to enter prescriptions electronically.  (It sounds complicated but I am assured it is not.  Ask!)
  • You can fill out a registration form and mail your paper prescription to Express Scripts.

If you have any questions or problems with these options, you can call the Member Choice Center at 1-877-882-3335 for more assistance.

Military Pharmacy

Tricare beneficiaries who wish to move their current retail prescription to a military pharmacy should plan ahead.  First, call or visit the pharmacy you plan to use to ensure that they carry your medications.  Then, learn their system, and perhaps see if you can figure out the times that they are super-busy.  Military pharmacies frequently have very long wait times (think hours), and outside prescriptions are sometimes the lowest priority category.

Sometimes military pharmacies participating in e-prescription programs that allow your physician to send the prescription to the pharmacy electronically.  You can see a list of participating military pharmacies on this PDF document.

If you have any questions or problems with these options, you can call the Member Choice Center at 1-877-882-3335 for more assistance.

What Drugs Are Changing?

If you take long-term medications, it might be hard to know whether your prescription falls under these new rules.  To check your medication, you can look up your prescription on the Select Drug List, or call Express Scripts at 1-877-363-1303.  If your medication falls on the Select Drug List, and you fill it at a retail pharmacy, you will get one covered refill after 1 October 2015.  After this date, you will be responsible for the full retail cost of the prescription.

When you get a new prescription for a drug that is listed on the Select Drug List, you can have it filled two times at a network pharmacy.  After that, you need to sign up for home delivery, or go to a military pharmacy, or pay the full retail cost of the drug at a retail pharmacy.

Who Doesn’t Have To Follow These Rules?

This change does not apply to:

  • active duty military members,
  • short-term medications, such as antibiotics,
  • generic medications,
  • beneficiaries living overseas,
  • beneficiaries who have other prescription drug coverage,
  • beneficiaries who apply for and receive a waiver to continue having their prescriptions filled at a retail pharmacy.  The may apply in emergencies or in situations such as a beneficiaries living in a nursing home.  Waivers can be obtained by calling Express Scripts at 1-877-363-1303.

The Tricare pharmacy contractor, Express Scripts, sent a letter to affected beneficiaries in September explaining their options.   If you are confused or have any questions, you can contact Express Scripts at 1-877-363-1303.

About the Author

Kate Horrell
Kate Horrell is a military financial coach, mom of four teens, and Navy spouse. She has a background in taxes and mortgage banking, and a trove of experience helping other military families with their money. Follow her on twitter @realKateHorrell.
  • Kathy

    We have used Express Scripts for our maintenance mess for over 3 years and have been very satisfied with their service. I had one instance where they were out of stock on one of my mess and I had to get it from a retail pharmacy. Our Doctor participates in e-subscribing so it is usually pretty simple.

  • Guest contributor

    There are TWO covered refills, not one after 1 Oct 2015, per the DMA website.

  • Cdr R retired

    Wonderful!!! I had a prescription with a regular scheduled refill at a CVS pharmacy. Imagine my surprise when I went to pick it up on SEPTEMBER 8, 2016 and was told I owed $398.00 on what was a $20.00 payment for the prior two prescription fillings (May and July) . UPON CALLING EXPRESS SCRIPT I WAS TOLD THAT THIS PROGRAM WAS EFFECTIVE IMMEDIATELY !!! Now they say October 1? SO much for my prescription – next Doctor visit I will get the paper and hit Luke AFB.

    Once again UNITEDHEALTHCARE has FAILED in providing us retirees TRUTHFUL and HONEST service…. I would like to have Tricare West back. They were great to work with.

    TRUST E-Script? NO CHANCE IN HELL !! They lied to me and I can no longer trust them

    • Spankey

      I too experienced similar problems here in California, the wild fires caused significant air quality issues and I am taking FloVent a prescription from my Allergist who originally prescribed a different inhaler, well ExpressScripts told my doctor that was not on formulary and I would have to try something else first if it failed then they might consider the original. Long story short Express Script denied my refill prior to Oct 1 and I was without the inhaler for a week when I had to file a Congressional Complaint, I was still without medication in extremely bad air for 5 days. The patient care does not come first and I resent the Express Scripts acting as my doctor they are not paid to do so nor do they know my health history. I believe this is at a point of going to court since no one seems to understand that our benefits are being taken away thanks to Obama Care (Non-Care).

      • Guest contributor

        Pleae understand that the requirement to change over to either Express-Scripts home delivery by mail or pickup at a military pharmacy has nothing to do with the ACA (Obama Care). The change over was a separate requirement that was written into the FY 2015 Defense Act to save the DoD money on it’s costs of prescription drugs for retirees and their family dependants.

        • Brian

          I have a pharmacy benefit through my HMO employer (my primary insurance carrier) which requires maintenance drugs to be filled as a 90 day supply by CVS either as mail order or in the store. My CVS pharmacy is real close to my house. I’m retired Air Force. I wonder how this affects having TRICARE (my secondary insurance) pay a share of these prescription costs.

  • Don

    I have been using Express Scripts for a number of years. They are OK but their communications are poor. When they send an email about a med it does not give the name or who it is for but references the NEW Rx# not the old so you have no idea especially if you and/or your spouse have several meds. Then have to go to the web site (which has been re-designed but not better) or make a phone call to figure out what happened. Also they have never been able to contact our doctors for refills and who are all high-tech/ computerized now. So I have to contact the doctor and have them send a re-fill request electronically.

    • John

      I agree with everything Don says. Time after time, they are unable to contact my clinic for refills

  • Watchin’ the fun

    Amazing – ! Just another “Do what we tell you to do, not what we do” mishmosh.

  • Jerry Retired HMC

    I just switched to Express Scripts for all my medications. It was not complicated and the staff was very helpful. I am very pleased with the change over. Also my wife has switched. No more, weekly trips to CVS who could not fill some of my prescriptions. Couldn’t be happier at this time.

  • J.Bennett USAF ret’d

    The system may work fine for people living in or near cities but rural area people, like me, think it is way less than desirable. Here in the mountains of Colorado there are times I cannot get to my mail box for days, mostly in the winter. None of the alternate delivery services can get to my house at these times. Is Tricare going to deliver by helicopter? The people making these decisions have their heads up and locked. I now carry another prescription insurance to avoid this bull.

    • Watchin’ the fun

      Now that “drones” are supposed to be able to deliver packages, why not suggest that for a delivery service ?

  • William White

    Express Scrips should allow us to give them permission to include the name of the Medication and the name of the recipient in our notifications. It’s now like getting a message saying “Somebody is getting Something”. If this is the best they can do, then just don’t send the stupid message. We generally know when they are due. If we don’t get anything for awhile, we will call them.

    • Guest contributor

      Express Scripts already has each customer’s permission to reveal the name of the medication being sent along with the name of the recipient patient. They were given that authority when the patient signed up for Rx by mail.

  • Laverne Sansing

    I have other insurance. When my pharmacy files for Express-Scripts to pay their part (TRICARE for Life!) they pay nothing. Have others had this treatment?

    • Willie

      Cancel your other ins. Tricare will pay the rest if you have part B medicare.

      • Brian

        I work for a California HMO and prescriptions is part of my medical benefit. I’m AF retired with TRICARE Supplement is my secondary insurance. In my case it does not make sense for me to cancel my private coverage.

  • Old Retired AF Vet

    Express Scripts which I used for over ten years is unable to communicate as several have pointed out. They seem to be completely terrified of the privacy laws. I found their service to be great until 18 months ago when my meds were “out of stock.” Then they started cancelling valid Rx’s, changing Rx’s and refusing to answer direct questions. Out of necessity I went to a local network pharmacy where I was the customer. At ES the DoD is the customer not the patient. ES does not have to keep you happy only the DoD. Congress is a joke on this issue. They think all is fixed because they passed a law.

    • ali, Ret MSgt, USAF

      I have had the same problems as you. They said one script was backordered (but local pharmacies had NO problem filling it) and that the script would be fillable 1 day after it expired! Have talked to ES numerous times about this issue and about them changing the RX’s but only receive answers that remind of a the deer in the headlights! Two years or so ago ES had pretty good customer service and I rarely had problems with them. That’s definitely not the case now. If we could rate them, I’d give them a big ole’ five thumbs down! You should see some of the comments made by the civilian sector…they too have problems with ES.

      • USFSPA Killer

        Did you give them the “one finger salute” ?

  • anna

    I have been really happy with express scripts.thanks

  • Alphonse Rainer

    I have been using Exress Scrips, for years.these peole I talk to are the most helpfull. they are well trained,polite and never have a bad hair day.THANK YOU SO MUCH.

  • Marty

    The Scripts “Worry-Free”RX renewal policy is commendable when applied as designed. However, when the prescribing Doctor declines to even answer Script’s request to approve a renewal, the term “Worry Free” is a joke, and the patient is required to contact/visit the Doctor’s office just to initiate a brand new RX, often running completely out of medicine before a new supply arrives. The system can work no better than a Doctor’s willingness to make it work.

    • Guest contributor

      In today’s world of “bare bones” medical insurance reimbursement to medical providers – i.e. Doctors, clinics, etc – the providers schedule a patient every ten minutes and then bill the insurance for an “hour” – 45 or 50 minute – visit. This is covert FRAUD – both to the patient and the insurance company ! These medical providers don’t have time to return calls to any medication dispensing facility let alone responsibly see their patients !

  • Paula

    So what happens if they don’t have your Name drug???

  • Guest contributor

    Call Express Scripts @ 1-877-363-1303 and ask for a waiver.

  • Larry Pruitt

    It would seem to me that Tricare-for-life members who have other insurance, that covers prescription meds, Express Scrips would be delighted to cover any
    remaining balance without all the saber rattling orders/requirements,etc. We are saving you money!!! Am I missing something??

    • Guest contributor

      As second/third final payer, TFL automatically covers all remaining co-pays and deductibles – no other ‘script med insurance is needed !

      • MBrad10590

        Bull. We still have to pay on most generic prescriptions, even though my mother has MHBP as primary for prescriptions and TFL as secondary. It does NOT cover it all. Until Express Scripts took over, they did. But, no, NOT now.

  • unhappy vet

    if anyone has a new script, it is near impossible to find out the price so we can chose another option… Just last month i was charged $40+ for a months supply,.. had I paid the full retail cost it would have only been two or three $ more.. .

    and automatic refills only works when they have the drug in if not they just send a letter and cancel auto refills…

    add that to its horrible website login and rotten customer service.. and it is nothing but another insult to our service..

    Congress should first try it out on themselves before they mandate we are switched over to the program..

  • Steve

    Express Scripts sounds like a good idea in theory, but falls way short in practice. Poor communications and even poorer problem resolution. If your primary care provider is military, stick with the military pharmacy!

  • Watchin’ the fun

    What is “MHBP?

  • Vernon R Cox

    We have been using Express Scripts for many years now and find the automatic refill great. Our Doctors work with Express Scripts and have not missed a beat. When we go away for an extended time, they are prompt with the change of address both going and coming back home. Kudos.

  • vacritt

    If you live near a military base, it is best to go there.