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Resources for Pharmacists & Pharmacy Staff

TRICARE Pharmacy Home Delivery

TRICARE Pharmacy Home Delivery (TMOP) is included in the TRICARE pharmacy benefit. With this option, beneficiaries can enjoy the convenience, safety & savings of receiving their medications delivered right to their home.

Home Delivery, serviced by Express Scripts, is recommended for maintenance medications and is the beneficiary’s least expensive option when not using a military pharmacy.

Benefits to beneficiaries include:

  • Up to a 90-day supply of most medications
  • FREE formulary generic medications
  • FREE standard shipping
  • Option for Automatic Refills
  • Medications shipped to the beneficiary’s home safely in a secure, weather-resistant pouch
  • Medications requiring temperature controls are delivered safely. Using innovative technology, medications are shipped in temperature-protective coolers with warming gel packs during frigid temperatures

More information:

Transferring Prescriptions in CHCS to TMOP (Direct Transfer)

Transfer of a prescription to the TMOP is accomplished via the Refill a Prescription (RAP) option in CHCS.

  • The menu path in CHCS to initiate the transfer of a script via TMOP is:
    Pharmacy Main Menu > OPM > PM > RAP
  • The beneficiary/user must confirm the accuracy of the patient’s address before a transfer can occur. The user will be asked if the patient’s address and telephone number are correct.
  • If the answer to patient’s address or telephone is “No,” the prescription will not be transferred. The prescription will then be put into suspense to be processed locally. If the answer to patient’s address or telephone number is “Yes”, the prescription will be transferred.

Eligibility

A refillable prescription may be transferred to the MOP if:

  1. The MTF to MOP Project lead has designated drug as mailable
  2. The beneficiary is eligible
  3. The following are correct and in the CHCS Patient’s File:

    • Beneficiary’s address
    • Beneficiary’s zip code
    • Beneficiary’s telephone number w/area code

Available Reports

CHCS provides two reports pertaining to TMOP:

  • TMOP Mailable Drug (FLA)
    Menu Path: Pharmacy Main Menu > PRM > OPR > TMO > FLA
  • TMOP Transfer Report (TMS)
    Menu Path: Pharmacy Main Menu > PRM > OPR > TMO > TMS

TMOP Mailable Drug Report

The TMOP Mailable Drug Report allows the site to easily determine which drugs have been flagged within the ADN function to transfer to the TMOP. This report provides the drug name and primary NDC number associated with every drug flagged for TMOP. The report sorts drugs by IEN. By capturing the report and exporting into Excel, you can sort it by drug name.


TMOP Transfer Report

The TMOP Transfer Report allows you to monitor the status of refills (rejected, accepted, both) transferred to the TMOP. The user can sort by Status, choose a time period (a maximum of software Activation date or T-365), and sort by Patient, Date or Outpatient Site.

If you are uncertain if script was transferred, please contact your Pharmacist in Charge, your MTF Home Delivery Super User, or check the TMOP Transfer Report.

MTF Pharmacy Help Desk

If you are experiencing any transfer difficulties, please contact your Pharmacist in Charge (PIC) or Super User, so that they can contact Express Scripts for research and resolution.

If your PIC or Super User is not available, please contact the Express Scripts MTF Help Desk at 855.315.1921. (Please Note: This number is for MTF pharmacy staff use only.)

If a beneficiary’s script has been successfully transferred from MTF to TMOP and if your beneficiaries have any questions regarding their transferred script, please have them call Express Scripts Customer Service at 877.363.1303 (TDD/TTY—877-540-6261)

Formulary Search Tool

Pharmacists and pharmacy staff members can use the Express Scripts TRICARE Formulary Search Tool (available online at express-scripts.com/TRICAREformulary) to obtain helpful information about drug coverage, including:

  • Whether a drug is designated formulary or non-formulary
  • Copay amounts for drugs at each point of service, including Home Delivery
  • Generic equivalent information for brand name medications
  • Prior authorization or medical necessity information, if needed, including links to necessary forms

Prior Authorization

For prescriptions that require a prior authorization or medical necessity review, forms are available on the Formulary Search Tool. Beneficiaries and providers can download and print the necessary forms and submit them to Express Scripts.

More information:

Prescription Monitoring Program

The Express Scripts Prescription Monitoring Program identifies TRICARE beneficiaries who exhibit possible unsafe behavior with regard to controlled medications. If a beneficiary is enrolled in the Prescription Monitoring Program, the program implements restrictions to prevent or decrease the risk of substance abuse.

Pharmacists can request that a patient be enrolled in the program by submitting this form.

  • Program candidates are identified via a quarterly query which incorporates prescriber, pharmacy and medication frequency along with controlled substance trends
  • Express Scripts sends the quarterly query report to the TRICARE MCSCs/DHA PASS for further review or recommendation for inclusion to the program
  • If approved, Express Scripts sends a letter to identified TRICARE beneficiaries informing them that they have been placed into the program. A selection form accompanies the letter instructing the beneficiary to designate one provider, one pharmacy and one hospital to receive medical and prescription services for their controlled medication.
  • If the beneficiary fails to respond, they will be responsible for 100% of pharmacy costs for all controlled medications.

More information:

Other Health Insurance (OHI)

If a TRICARE beneficiary has health insurance coverage with a prescription plan in addition to TRICARE, such as coverage through an employer or a private plan they’ve purchased, it is known as other health insurance (or OHI). It is important for them to know what is required of them and how their two plans work together.

Comprehensive information about Other Health Insurance is available here.

More information:

Specialty Medication Care Management Program

Express Scripts has resources to help patients taking specialty medications manage their conditions. TRICARE beneficiaries who are taking a specialty medication and are enrolled in TRICARE Pharmacy Home Delivery receive additional benefits from the Specialty Medication Care Management Program, including:

  • Access to nurses and pharmacists, and social workers specializing in complex disease states
  • Specialty patient care advocates to answer questions and process medication requests
  • Scheduled medication deliveries to the patient’s specific location
  • Refill reminder calls to help the patient stay adherent
  • Nurses will contact the patient’s provider to discuss any side effects and/or changes in condition as reported by the patient during scheduled phone calls
  • Specialty consultations with a nurse or pharmacist at any point during your therapy

Express Scripts also offers the following services to beneficiaries with certain chronic diseases (such as multiple sclerosis, rheumatoid arthritis, hepatitis C and psoriasis):

  • Nurse outreach with scheduled phone assessments
  • Proactive, structured clinical assessments
  • Comprehensive patient education for disease and drug therapy
  • Help to achieve the best drug utilization and adherence

More information:

Deployment Prescription Program

Resources are available for TRICARE beneficiaries preparing to deploy which allow them to obtain prescription medications while in theater. Through the Express Scripts Deployment Prescription Program, in-theater beneficiaries can receive their medications through TRICARE Pharmacy Home Delivery.

For questions about the Deployment Prescription Program, contact the Deployment Account Management team:

  • Email: DeployedPrescriptionProgram@express-scripts.com
  • Phone: 855.215.4488 or 314.684.7506 between the hours of 8am — 8pm CST Monday through Friday If you are calling after hours, leave a voice mail with your name, reason for your call and the best way to contact you. Express Scripts will return your call or send you an email.

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