TRICARE For Life Pharmacy Pilot Program
Express Scripts is committed to serving TRICARE® For Life (TFL) beneficiaries in this important Pilot Program. To ensure you experience a positive outcome, we stand ready to assist you with your TRICARE Pharmacy Home Delivery needs. Beneficiary satisfaction ranks first on our list of priorities and we want you to know we are proud and honored to serve you. We take very seriously our mission to serve those who have served our nation.
As you begin to enjoy the benefits of TRICARE Pharmacy Home Delivery, we hope you’ll appreciate the convenience and peace of mind that comes with having your maintenance medications safely and securely delivered right to your home. TRICARE Pharmacy Home Delivery is a cost-effective way to receive all of your maintenance medications and there are multiple checkpoints that enhance safety and accuracy.
As caring stewards of your pharmacy benefit, you know it is important to be fiscally responsible, especially in these challenging times. Join those who have already chosen the convenience, safety and savings of Home Delivery, plus:
- It’s safe, convenient and easy to get started. Register or login here
- Formulary generics are free
- Worry Free® Fills: automatic refills and shipment options designed to ensure your medications are available on time without lapse
- Save with up to a 90-day supply of your medication
- Delivery to the address of your choice with no cost for standard shipping
- Access to a pharmacist 24/7
- Get Specialty medications and the Specialty Medication Care Management Program is free to you
Express Scripts is dedicated to serving TFL beneficiaries to optimize the health of the military family. We are aligned in supporting readiness through improved health, a positive patient experience and responsible management of health care costs.
What Is It?
In 2013, Congress passed a law creating a pilot program that requires TRICARE For Life (TFL) beneficiaries to use TRICARE Pharmacy Home Delivery or a military pharmacy to fill select maintenance medications.
The pilot only applies to TFL beneficiaries who fill select maintenance medications at a network retail pharmacy. Maintenance medications are those for chronic, long-term conditions that you take on a regular, recurring basis. This doesn’t include medications taken for a sudden illness or infection, such as antibiotics or short term pain relief. If you fill these prescriptions at a retail pharmacy, this new pilot will help you save money - and it’s more convenient for you.
If the pilot applies to you, you should receive a letter from the Department of Defense in February. You may also call Express Scripts at 1-877-363-1303 to see if the pilot applies to any of your prescriptions.
What Are My Options?
If you have a prescription covered by the pilot, you will need to choose where to fill it. You can choose any of the following options:
Transfer your prescription from a retail pharmacy to safe, convenient TRICARE Home Delivery and pay less money out-of-pocket! A typical cost for a 90-day retail supply of brand name medication is $51, but only $13 through Home Delivery.
Transfer your prescription from a retail pharmacy to a military pharmacy. Call your local military pharmacy to see if they can fill your prescription.
Ask your doctor about using a low-cost generic medication that is not affected by the pilot. You can still fill these medications at a retail pharmacy for $5.
Continue to get your prescription filled at a retail pharmacy and pay 100% of the cost, starting with your third fill.
If you refill select maintenance medications at a retail pharmacy after March 14, 2014, you'll receive a letter reminding you about the pilot. Remember, starting with your third fill after March 14, you’ll be responsible for the entire cost of the medications if you get them from a retail pharmacy.
If you have other health insurance with a prescription benefit, you aren’t part of the pilot. In some cases of personal need or hardship, emergency, or other special circumstances (such as living in a nursing home) you will be able to request a waiver.
We encourage you to consider your options carefully. If you're ready to make the switch to Home Delivery, call 1-877-882-3335 now to get started!
How Will I Be Notified?
In February, the Department of Defense will send you a letter explaining the pilot, and telling you that if you continue filling select maintenance medications at retail pharmacies, you must pay the full cost, starting with the third fill after March 14, 2014.
The two courtesy fills at a retail pharmacy give you time to choose where to fill your prescription. The letter will clearly explain your options, and give you easy instructions on how to switch to Home Delivery.
You may also call Express Scripts at 1-877-363-1303 to see if the pilot applies to any of your prescriptions.
Starting after March 14, 2014, Express Scripts will send you a letter after you fill your first prescription at a retail pharmacy. The same letter is sent if you fill your prescription a second time at a retail pharmacy. If you do not utilize a military pharmacy or enroll in TRICARE Pharmacy Home Delivery by the third fill, you will pay full price at a retail pharmacy.
Follow Up Letter:
If you exceed your two courtesy fills and continue to use a retail pharmacy and pay full price for your prescription, Express Scripts will mail you a follow up letter about converting to Home Delivery.
You can opt out of the pilot after using Home Delivery for at least a year. In some cases, you may be able to get a waiver.
What Are The Benefits Of TRICARE Pharmacy Home Delivery?
Convenient – With TRICARE Pharmacy Home Delivery, picking up your prescriptions is as easy as picking up your mail. Prescriptions are delivered to your home–eliminating trips to a retail or military pharmacy. Sign up for Worry-Free Fills® and your prescription will be sent to you when it’s time for a refill. You can also request refills by phone, or online 24 hours a day, seven days a week.
Effective – TRICARE Pharmacy Home Delivery is your most cost-effective option when not using a military pharmacy. You get significant savings compared to a retail pharmacy with a 90-day supply of your prescription. You pay nothing for shipping and handling, plus you save your valuable time and the cost of gas.
Safe – Your prescriptions are filled using an automated dispensing system ensuring a high degree of accuracy. A registered pharmacist checks your medication history for possibly harmful interactions. For your protection, medications are delivered in a plain, secure weather-resistant pouch.
It is well-documented that people are more likely to take their medication as directed by their doctor when they use Home Delivery. You can also sign up for Worry-Free Fills and manage your prescriptions through the enhanced Express Scripts Mobile App. The savings and convenience of TRICARE Pharmacy Home Delivery contribute to improved compliance and better health.
Where Can I Get More Information?
For more information about the TRICARE For Life Pharmacy Pilot:
- Read the Fact Sheet (PDF file)
- Call Express Scripts at 1-877-363-1303
- Visit www.tricare.mil/TFLPilot for more information as it becomes available.
- A list of medications covered by the pilot is available online at: http://pec.ha.osd.mil/TFL_maintenance_drug_list.php.
- Medications covered by the pilot are determined by the Secretary of Defense and must be available for an initial filling at a retail pharmacy. The Secretary may exempt medications for acute care needs or any other medications the Secretary determines to be appropriate for exclusion.
- TFL beneficiaries may opt out of the program after filling a prescription through Home Delivery for one year. The Secretary may also waive the requirement of a TFL beneficiary to participate in the Pilot program on an individual basis if the Secretary determines a waiver is appropriate.
- For the purposes of this program, “TRICARE For Life beneficiary” indicates a TRICARE beneficiary enrolled in the Medicare wraparound coverage option of the TRICARE program made available to the beneficiary by reason of section 1086(d) of title 10, United States Code.
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