TRICARE Senior Pharmacy Benefit Details Announced

The Department of Defense announced that on April 1, 2001, uniformed services beneficiaries 65 years of age and older will begin receiving pharmacy benefits provided by the 2001 National Defense Authorization Act (NDAA). An estimated 1.4 million beneficiaries are eligible for the benefit.

The new program will limit their out-of-pocket costs and increase their access to the National Mail Order Program (NMOP), and retail pharmacies that are part of the Department of Defense (DoD) network, which include many major chain drug stores. In addition, they may use non-network retail pharmacies.

"Drug therapy, for many of our older retired service members, is one of their greatest and most costly medical needs. This is a comprehensive drug benefit that makes pharmacy care accessible and affordable. This expanded benefit should contribute significantly to their quality of life," stated J. Jarrett Clinton, M.D., acting assistant secretary of Defense for Health Affairs.

Beneficiaries who are 65 years of age and older will not pay enrollment fees or annual premiums for their TRICARE pharmacy benefits, but they will pay modest co-pays when they use NMOP and retail network pharmacies. In addition, beneficiaries will also be able to use non-network pharmacies, but this option will entail a slightly higher co-pay and deductible. In the past, only those beneficiaries who were eligible for Base Realignment and Closure (BRAC) benefits and the Pharmacy Redesign Pilot Program (PRPP) were able to enjoy modest out-of pocket costs through the NMOP and retail pharmacy network. The BRAC pharmacy benefit and the Pharmacy Redesign Pilot Program are replaced by the new program.

By law, to use the TRICARE retail and mail order benefit, beneficiaries age 65 and over must be eligible for Medicare Part A and enrolled in Part B. There is an exception: Those who turn 65 before April 1, 2001, are eligible for the benefit, even if they are not enrolled in Medicare Part B.

Effective Oct. 1, 2001, Medicare-eligible military beneficiaries become eligible for all other TRICARE benefits. The law requires that all Medicare-eligible beneficiaries, regardless of age, must be enrolled in Medicare Part B to receive the other TRICARE benefits; and they are advised to enroll in Part B as soon as they are eligible. The annual open season for enrollment in Medicare Part B is Jan. 1 through March 31. Information about Medicare enrollment is available at local Social Security Administration offices, or on the Medicare Web site at http://www.medicare.gov/Basics/Overview.asp.

Retired beneficiaries living overseas can use their TRICARE benefit at overseas pharmacies, but they will need to submit their pharmacy claims for reimbursement. They also will be able to utilize the NMOP, if certain requirements are met. Federal and state legal restrictions apply to the prescribing, dispensing and mailing of prescription drugs, so the NMOP can only mail to APOs and FPOs, which are part of the U.S. Postal Service. Also, the NMOP can only fill prescriptions written by providers licensed to practice in the United States.

The NMOP offers the largest discount to DoD beneficiaries. It is convenient for filling prescriptions for chronic conditions like high blood pressure or diabetes. The retail network pharmacy program can be used for short-term, immediate use medications. Lists of TRICARE network pharmacies will be available from regional TRICARE contractors. Beneficiaries who use non-network pharmacies will have to meet an annual deductible, incur a higher co-pay, and pay the entire bill up front, and then file a claim for appropriate reimbursement.

One of the most important steps eligible beneficiaries can take to be sure they can use the expanded pharmacy benefit is to update their Defense Enrollment Eligibility Reporting System (DEERS) record with their correct address and any changes in family status, such as marriage, divorce, birth or adoption.

Eligible beneficiaries may update their addresses in DEERS in a number of ways: By visiting local personnel offices that have an ID card facility; by calling the Defense Manpower Data Center Support Office (DSO) Telephone Center at 800-538-9552 (The best time to call the Telephone Center is Wednesday through Friday, between 9 a.m. and 3 p.m. (Pacific Time) to avoid delays); by faxing changes to (831) 655-8317; by mailing the change information to the DSO, Attn: COA, 400 Gigling Road, Seaside, CA 93955-6771; by visiting a Military Treatment Facility; by E-mailing information to addrinfo@osd.pentagon.mil and including the sponsor's name and social security number, name(s) of other family members affected by the address change, effective date of address information, and telephone number (to include area code), if available. Internet users should use all lowercase letters because some e-mail systems are case sensitive.

To change information in DEERS other than address data, beneficiaries may visit an ID card facility, or mail or fax changes with appropriate documentation to the address or fax numbers provided above. For beneficiaries to learn what documentation is required, they should contact the nearest military ID card facility.