Starting Oct. 24, about 15,000 independent pharmacies will no longer be in the TRICARE retail pharmacy network. Even with the departure of these community pharmacies, the network will still offer access to more than 40,000 pharmacies.
Express Scripts, the TRICARE pharmacy contractor, manages the TRICARE pharmacy retail network under a contract with the Department of Defense. This network change will be implemented in preparation of the next TRICARE pharmacy contract.
“The Defense Health Agency is confident that the new pharmacy contract maintains the quality of the TRICARE retail pharmacy network,” said Edward Norton, Jr., chief of the Pharmacy Operations Division at the Defense Health Agency. “Some independent pharmacies are leaving, but TRICARE families will continue to have access to an excellent network of pharmacies.”
Over 90% of beneficiaries will have at least one network pharmacy within 15 minutes of their home. Your TRICARE pharmacy retail network includes:
In mid-September, Express Scripts sent a letter to all who are affected, notifying them of the change. This letter contains a list of other network pharmacies near you. You can also use the Find a Pharmacy tool on or after Oct. 24 to find retail network pharmacies in your area. Express Scripts will update the online search tool once the network changes go live this month.
If you do have a prescription at one of the pharmacies leaving the network, and would like to transfer it to a new retail network pharmacy before Oct. 24, you can. Here are three easy ways to move your prescription:
What other options do you have? TRICARE Pharmacy Home Delivery or a military pharmacy may be lower cost options for you. You’ll have to pay copayments when you use home delivery or go to any retail network pharmacy. However, home delivery offers up to a 90-day supply for a single copayment. At retail network pharmacies, it costs three copayments to get a 90-day supply. Visit the TRICARE Costs page to view pharmacy copayments for your health plan.
You can also visit the Express Scripts website to transfer eligible medications to home delivery. You can also go to a military hospital or clinic near you.
What will happen if you fill a prescription at a pharmacy that has left the TRICARE network? As noted in the TRICARE Pharmacy Program Handbook, if you use a non-network pharmacy, you’ll pay full retail price for your medication. You’ll need to file a claim for reimbursement. Your claim will be subject to a deductible or out-of-network cost-shares and copayments.
Do you use specialty prescription drugs? Starting Jan. 1, 2023, Accredo will be the primary TRICARE in-network specialty pharmacy. If you get specialty drugs at one of the affected pharmacies, you can switch to Accredo now. You don’t have to wait until January. For more on using Accredo to fill your specialty prescription drugs, call 1-877-882-3324. You can also go to the Accredo website.
Have questions about network changes or other aspects of your TRICARE pharmacy benefit? You can learn more by checking out the Pharmacy section of the TRICARE website or by contacting Express Scripts.
Original article written by TRICARE here.