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Decoding Prescriptions: Understanding key pharmacy terms and abbreviations

Pharmacy terminology can be confusing. To make the most of your TRICARE® pharmacy benefit, it is essential to understand some key pharmacy terms. The following is a list of some of the most common terms you may encounter.

Brand-name drugs

Brand-name drugs are marketed under a trademark protected name. Brand-name medications can only be produced and sold by the company that holds the patent for the drug. If the patent has expired on a brand name drug, there may be generic versions available.

Copayment

A copayment (or copay) is a fixed-dollar amount you pay for a medication. It is usually paid at the time of service. The amount can vary by the type of medication (such as formulary or non-formulary) and place of service (using a Military Treatment Facility, Home Delivery or a retail pharmacy). Copayments are the most common form of out-of-pocket expense for prescription drugs.

Compound drug

A drug that is created by a pharmacist mixing multiple ingredients together to create a prescription drug that is specific to a beneficiary’s needs. Express Scripts screens all TRICARE compound drug prescriptions to ensure each ingredient is safe, effective and covered by TRICARE.

Deductible

The annual amount a TRICARE Standard, TRICARE Extra, TRICARE Overseas Program Standard, TRICARE Reserve Select or TRICARE Retired Reserve beneficiary must pay for covered outpatient benefits, including pharmacy services received at non-network pharmacies, before TRICARE begins to share costs. TRICARE Prime beneficiaries do not have annual deductibles unless they use the point-of-service option.

ePrescription

An ePrescription, or an electronic prescription, is a computer-generated prescription sent electronically from your prescriber’s office directly to a pharmacy. ePrescribing provides accurate and error-free prescriptions.

Explanation of Benefits (EOB)

A statement sent to beneficiaries showing that claims were processed and the amount paid to providers.

Formulary

The TRICARE Formulary is a list of generic and brand name prescription drugs that TRICARE covers.

Generic drugs

Formulary Generic drugs are medications approved by the Food and Drug Administration (FDA) that are clinically the same as brand-name medications. Generic drugs provide the same effective treatment as brand-name drugs and help you save money. The FDA requires that all generic drugs meet the exact same standards for effectiveness, safety and quality as brand-name drugs.

Non-formulary

Non-formulary medications include any drug in a therapeutic class determined to be not as clinically effective or as cost-effective as other drugs in the same class. Non-formulary medications for TRICARE may be either brand or generic drugs.

Maintenance Medication

Maintenance medications are medications that you take on a regular basis and are prescribed for chronic, long-term conditions. Examples of chronic conditions that may require maintenance medications are: high blood pressure, high cholesterol and diabetes.

OHI (Other Health Insurance)

Any non-TRICARE health insurance that is not considered a supplement. This insurance is acquired through an employer, entitlement program or other source. TRICARE pays last after all other health plans except Medicaid, TRICARE supplements, the Indian Health service or other programs or plans as identified by TRICARE.

OTC Drugs

OTC Drugs are medications sold Over the Counter and can be obtained without a prescription.

Point of Service

Point of Service or POS are designated places that you can have your prescriptions filled. TRICARE beneficiaries have four service options:

  • Military pharmacies
  • TRICARE Pharmacy Home Delivery Program
  • TRICARE retail network pharmacies
  • Non-network pharmacies

Prior authorization

Prior authorization is a process of reviewing certain medical, pharmacy, surgical and mental health care services to ensure medical necessity and appropriateness of care before services are rendered or within 24 hours of an emergency admission.

Specialty medication

Drugs used to treat serious chronic conditions. Specialty medications are usually high-cost, self-administered, injectable, oral or infused drugs. These drugs typically require special storage and handling and are typically not readily available at your local pharmacy. Specialty medications may also have side effects that require monitoring by a healthcare professional.

These are some of the most common pharmacy terms that will help you better understand your TRICARE benefit. If you have questions about your pharmacy benefit, you can contact Express Scripts Customer Service at 1-877-363-1303.




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