New TRICARE Pharmacy Co-Payment Adjustments Set to Start & Update on TFL Mandatory Mail Order

Jan 29 2013

pharmacyThe new copayments for prescription drugs covered by TRICARE will go into effect Friday February 1, 2013. The Fiscal Year 2013 National Defense Authorization Act requires TRICARE to increase copays on brand name and non-formulary medications that are not filled at military clinics or hospitals. There is no increase to copays for generic medications.

By way of history, while not a fan of raising rates, we did recognize that these adjustments were the “lesser of the evils” which otherwise would have been foisted upon us.  We supported the fact that for fiscal 2014 and beyond, the new law which directs that copays increase annually by only the same percentage as retiree cost of living adjustments. In years when a COLA increase would total less than a dollar, it will be delayed a year and combined with the next adjustment so increases will always be $1 or more.

TRICARE Pharmacy copays vary based on the class of drug and where beneficiaries choose to fill their prescriptions. The copay for generic medications stays at $5 when a prescription is filled at a network pharmacy. There is no co-pay when generic prescriptions are filled through TRICARE Home Delivery. The new copay for a 30-day supply of a brand name medication purchased at a retail network pharmacy will be $17, up from the current $12. Beneficiaries using TRICARE Home Delivery will pay $13 for brand name drugs, up from $9. However, the Home Delivery price is for a 90-day supply.

The greatest change in copays applies to non-formulary medications. The $25 copay for these drugs increases to $44 at retail pharmacies and $43 through Home Delivery. The  TRICARE Uniform Formulary is a list of all the medications TRICARE covers.

Pharmacies at military hospitals and clinics will continue to provide medications with no copays.

Additionally, we have received numerous inquiries regarding the start-up of one of the other key 2013 legislative provisions – the mandatory home delivery of maintenance medications for TFL beneficiaries.

Recall that this provision requires a 5 year pilot program that requires beneficiaries to receive certain maintenance medications for a trial period of 1 year (with the option to opt out after that period if so desired).

In our discussions with TRICARE pharmacy leadership, we understand that the development of the implementation and execution plans will take some time.  Our best forecast at this juncture, is that the program will start in the summer or early fall 2013 time frame.  MOAA is planning to participate in this process by offering the perspectives of the beneficiary.

So stay tuned, more to come!

69 responses so far

69 Responses to “New TRICARE Pharmacy Co-Payment Adjustments Set to Start & Update on TFL Mandatory Mail Order”

  1. David Muelleron 01 Feb 2013 at 3:09 pm

    Thankfully, I have only two maintenance medications. Both are prescribed through the VA and provided by the VA pharmacy system. How will the TFL requirement for one year of mail order delivery affect me?

  2. Graydon Hickson 01 Feb 2013 at 3:21 pm

    Wife and I have been using the mail-order drug fulfillment of Express Scripts for several years. First couple of years with a civilian health insurance plan offered through my work with Northrop Grumman. Continued this after civilian retirement and transferred to the Tricare Express-Scripts as retired Air Force coverage using Tricare Standard. Now I’m using Express-Scripts with my Medicare and TFL health coverage while wife continues Express-Scripts with her Tricare Standard coverage.

    It has worked superbly! Fast response and excellent response to both computer contact and telephone calls. Whether I mailed in the prescription or the doctor mails in the prescription, it gets filled in less than a week. And if we need an immediate fill of a prescription, a small amount (generally 30-days) can be filled from our local pharmacy to last until the larger amount is started.

    I’ll preach the benefits of mail-order pharmacy to anyone willing to listen.

  3. Keith Toepferon 01 Feb 2013 at 3:27 pm

    The Tricare Mail Order Pharmacy requirement can be generally very good, based on my use of it over the past 20+ years for maintenance medications. However, there is at least one set of circumstances under which it is virtually unworkable. That latter case is for someone on controlled pain medications for chronic pain.

    My wife attempted to use TMOP for about a year in 2011-2012 for back pain resulting from a 1970s auto accident that cracked three lumbar vertebrae, contributed to by knee pain resulting from the removal of the synovial membrane in a Navy hospital when she was 13 years old, and a broken left femur in 1980 for which she still retains the steel plate and screws. Her doctor put her on a maintenance prescription for Vycodin, for which automatic refills are not allowed (at least in Washington State). No matter whom she spoke to at TMOP she was unable to get the renewal prescription to them every 90 days in sufficient time to avoid a several day period between her old prescription running out and the receipt of her next order. In order to avoid a quarterly 5-7 day absence of medication, she eventually had to resort to taking a prescription to the local Tricare Pharmacy contractor (Rite-Aid) to have it refilled the day prior to her running out of medication.

    With Vicodin now scheduled to be placed in a more restrictive category of medication, I see no way that the situation can do anything but deteriorate. We live near Seattle, which puts us over an hour (each way) from Joint Base Lewis-McChord and something of the order of 30-40 minutes (each way) from the MTF (if there is one) at Naval Station Everett, WA. How does one go about getting an exemption from the one-year trial for that medication? If it is not possible to do so, then the government has failed to live up to its promises with respect to Tricare for Life.

  4. Bonnie Jameson 01 Feb 2013 at 3:37 pm

    I might as well just pay for the drugs. It would be cheaper. I checked with three pharmacies and the cost to pay for the meds was cheaper than the co pay. Now in my area I find that 2 of my DRs are no longer taking Medicare so I will have to pay out of pocket for that. Might as well not have Medicare or TRicare!

  5. Major Vern J. Pall, USAF-RETon 01 Feb 2013 at 3:42 pm

    Very interesting and timely. But why can’t we get this information in the former format that was so easy to cut and paste into our local MOAA newsletters? We don’t need the colors of the rainbow. And why can’t we have a printer friendly option? Simply put, why can’t we have a product tailored to the needs of the MOAA members in the field rather than the staff at the national office?

  6. AEM USN Reton 01 Feb 2013 at 4:15 pm

    My wife has had the same experience as described above with obtaining a narcotic medication from the Tricare Mail Order Pharmacy. These drugs cannot be refilled, and and can only be filled for a 30 day period, after which a new prescription must be then submitted. Furthemore, prescriptions for narcotics cannot be faxed or electronically submitted to TMOP and must instead be mailed. Given the uncertainties of the mail and the TMOP processing, it is impossible to be able to rely on delivery before the medication at home is empty. Thus, I also have had to rely on a local retail pharmacy and hope there will be an exemption from the one year trial of using the TMOP for narcotic medications.

  7. Michael Furlichon 01 Feb 2013 at 4:36 pm

    No one has yet to explain how this mandatory mail order will work with other insurance

  8. George Hornon 01 Feb 2013 at 4:41 pm

    Tricare needs to determine what kinds of exceptions to the TFL requirement will be implemented and how to request them. Have heard that some of all generics may be excluded from the requirement. I believe they also need to look into TFL recipients living in institutional environments (ex. nursing or assisted living facilities) as often these organizations are set up with local pharmacies to provide prescriptions via special med inventory/dispensing systems. Having to obtain meds through TMOP and then send them out for repackaging is ridiculous.

  9. Col. Steve Strobridge, USAF-Ret.on 01 Feb 2013 at 4:44 pm

    Dod already has indicated that nursing home/assisted living patients subject to special packaging requirements will be exempted from the mail-order requirement.

  10. Col. Steve Strobridge, USAF-Ret.on 01 Feb 2013 at 4:46 pm

    Patients with other commercial health insurance aren’t authorized to use the mail-order system.

  11. Col. Steve Strobridge, USAF-Ret.on 01 Feb 2013 at 4:47 pm

    TRICARE requirements don’t apply to medications obtained through the VA. But the VA has its own mail-order refill requirement for maintenance medications.

  12. Thomas Hawkon 01 Feb 2013 at 4:50 pm

    I am a retired USAF officer. My wife is retired USAF civil service.
    We do not know to comply with the new TFL trial rules.
    We are both on Medicare. We are both covered by my wife’s FEP Blue Cross/Blue Shield (Federal Plan) and TFL.
    We have health maintenance medications that we get at CVS pharmacy. CVS checks all three insurances for reimbursement. Military Bases are over 1 1/2 hours away.
    In the past we have not been eligible to use the TMOP because we have OHI (other health insurance namely BC/BS).

    Even if we could use TFL pharmacy, we would go from basically no charges for our medications to having to pay the much more TFL copays. This makes no sense.

  13. CAPT Kathryn M. Beasley, USN.Ret.on 01 Feb 2013 at 4:50 pm

    We understand that narcotic drugs will be excluded from requirement of exclusive home delivery and therefore will not need to be filled at Home Delivery. The program will focus on maintenance medications only. Although there are a few narcotics utilized for chronic conditions (i.e. stimulants for Attention Deficit Disorder or drugs for Narcolepsy), all narcotics are exempt from exclusive home delivery requirement.

    If the narcotic prescription is mailed to ESI in a timely manner it is possible to get the refill before the home supply runs out, but it is good to know that refills can be managed with a local retail pharmacy.

  14. CW5 (Ret) F.L. Bateson 01 Feb 2013 at 5:41 pm

    I am AUS Retired and utilizing Tri-Care Standard in filling prescriptions at local MTF with civilian doctor written orders. I understand at reaching MediCare eligible age, both my wife and I will be required to pay fees for part B in order to move into TCFL. Part B premiums in 2014 will be $247/mo each. That is $494/mo or $5920/yr for a benefit that the military promised me 42 years ago would be free. What a deal! I am also covered under FEHB as a Civil Service retiree. My plan is to stick with Aetna and let TCFL and Obama Care go their merry way….

  15. Royce Milleron 01 Feb 2013 at 6:18 pm

    On average, these co-pay increases are essentially reductions in our retirement benefit. They have the same net effect on our personal finances as if our retirement pay was reduced. The Congress giveth and the Congress taketh away. So much for the promises made to recruit and retain personnel.

  16. Royce Milleron 01 Feb 2013 at 6:39 pm

    It would probably be useful if a clear description were given as to what is and what isn’t a maintenance prescription.

    It seems to me that any prescription that does not authorize refills would by description not be considered to be a maintenance prescription, and any that authorizes refills for 360 days worth of the medication would be considered a maintenance prescription. But, where in between these two cases is the line that separates maintenance from non-maintenance?

    Also, how about getting started on a maintenance medication? Does one have to wait until the mail order system can provide the initial delivery?

  17. Brenda Geiston 01 Feb 2013 at 8:09 pm

    With the new rules are we allowed to change a prescription from Express Script that will cost the high rate and have it filled at a military base pharmacy?

  18. D Jameson 01 Feb 2013 at 8:22 pm

    My husband is a severe diabetic and on a kidney transplant list. He takes a regimen of meds which have enabled him to stay off of dialysis (along with strict diet), while awaiting a transplant for over 4 years. His nephrologist and family doctor have worked together to establish a delicate balance of these drugs. What happens if some of the drugs he is now taking are not available through the MOP?

  19. LDO LT Jerry Steverson, USN (RET)on 01 Feb 2013 at 9:19 pm

    @ Graydon Hicks: Would you outline the procedure for obtaining short supplies of maintenance meds from a local pharmacy, if required, when the parent prescription is being filled by home delivery? Does it require an extra trip to the doc for a short supply prescription? That is my main concerns with home delivery, although I’m with you in singing home delivery’s praises. I have two meds being supplied that way, and it has worked like a charm so far. Absolutely free too, since I use generics.

  20. Sheldon B. Segermanon 01 Feb 2013 at 9:53 pm

    Hats off to AEM USN Ret. concerning the mail in service of express scripts. I do it all by computer and it takes seconds to do. I now have automatic refill. they notify me they are going to refill at a date.. If I want to change it, again seconds to do it. My doctor now does the RX updates electronicly. Why anyone would want to pay more for RX meds and have to drag off to the store for refills is beyond me. After you sign up which does take a few minutes (well worth it) the amount of time you spend on refills in microscopic.

  21. COL R.R.BOOTH, USAR RETon 01 Feb 2013 at 11:43 pm

    THANK YOU MOAA!! I HAVE RCVD NOTHING FROM DOD ON THIS NEW DRUG PLAN. OF MY 11 MEDICATIONS I FIND I CAN GET 5 OF THEM FROM RAYLE’S PHARMACY CHEAPER THAN EXPRESS SCRIPTS COPAY!! WALMART IS SUPPOSE TO HAVE SIMILAR PROGRAM. RRB

  22. Col. Steve Strobridge, USAF-Ret.on 02 Feb 2013 at 11:11 am

    One-time prescriptions are still filled At retail stores. Mail order is for refills. If you have a ProbLem with refills being delivered on time, call express scripts and they’ll either ship it quickly or arrange a temporary fill at a retail store.

  23. Col. Steve Strobridge, USAF-Ret.on 02 Feb 2013 at 11:12 am

    Medications not available by mail are still filled at retail stores or military pharmacies.

  24. Col. Steve Strobridge, USAF-Ret.on 02 Feb 2013 at 11:12 am

    Yes, you can still get them filled at military pharmacies.

  25. Col. Steve Strobridge, USAF-Ret.on 02 Feb 2013 at 11:17 am

    You need to get your doctor to write a 3-month prescription. You can ask the retail store to give you a 30-day fill to tide you over until your mail-order delivery starts. Maintenance meds are those that will require regular refills. Dod will put out info on which ones need to be refilled and which ones are exempt from the mail/military pharmacy refill requirement. We expect many generics will be exempt because they cost no more for DoD to refill through retail stores.

  26. MFG LTC USA (Ret)on 02 Feb 2013 at 12:43 pm

    My wife was using TMOP/Express Scripts for a “maintenance” Rx until we got a letter from them saying they could no longer supply the med and directed us to go to the local pharmacy. Then last week I tried to get a Rx for me transferred from the local pharmacy to TMOP/Express Scripts. A complete Goat Rope. Couldn’t get TMOP to accept the Rx even when sent directly from the Doctor. I envision more than a bit of problems getting that mandatory trial off the ground.

  27. MSLon 02 Feb 2013 at 1:41 pm

    Mail order? Experience trying to help a comrade, USAF(Ret), showed that this was like the ring-around-the-telephone game that many of us who were so well-trained by government! Nearest MTF for him, for me, and others where I live is roughly two hours away. Treatment: Does this have to do with retention of health care personnel? Gotta have sick people for our practitioners to practice on. Get real! If it isn’t in the computer, it can’t exist! My list is long.

  28. LTC Chris Thompson, ARNG, retiredon 02 Feb 2013 at 2:33 pm

    Mom is a 91-year old surviving spouse on Medicare and TFL who lives on her own — without a computer — 1300 miles away from me. I called both TriCare and Express Scripts last week to inquire about the best way to handle this new requirement for her, and pointedly, to see if she could opt out. Neither rep with whom I spoke knew anything about this new requirement. The TriCare rep asked her supervisor, who also knew nothing. Mom enjoys visiting her local pharmacy where they know her by name and take very good care of her. Her question echoes in my head: Why do I have to change? Any advice?

  29. Tony Vydraon 02 Feb 2013 at 2:35 pm

    My wife and I signed up for Express Scripts and were met with several drawbacks. The most important was that despite her MD’s repeated letters and fax’s, the TRICARE mail order pharmacy refused to accept his insisting for her Rx be NON-generic. (Aren’t physicians a wee bit more qualified than TFL)… So this necessitated out of pocket costs. Secondly, after you get to add up the costs, the discounts given us by our Grocery/Pharmacy, the local pharmacy is cheaper, closer( ten minutes) and more responsive. Further, we have two homes, and being retired, we move around at will…as you would expect, the response times for the bureacracy to get Rx’s re-sent, or re-directed, is poor. Finally, the entire process, from initialization, telephone calls, status updates (at least 40 to 50% inaccurate), lag times and delivery, the TFL experience is a blood-pressure
    factor!
    We finally had to cancel our TFL Rx experience, and have had no problems locally.

  30. Russ Hendersonon 02 Feb 2013 at 3:40 pm

    Finally, some one I can express the same message I will send a year from now to Express Scripts.
    You failed me before and I truly believe you will fail me again.

    I have an appointment in the near future with my doctor. from there I will arrange for Express Scripts to handle my home delivery.

    Oh, when I called them to question how they were going to not fail, they couldn’t even see the problem–that was where we were the last time when I had to find a real pharmacy to support my prescription needs. And they have never failed me! Not one time.

  31. Kate M Marnaneon 02 Feb 2013 at 4:15 pm

    I am reluctant at this point to have my medications filled by mail order. When I receive a new prescription that must be filled that day, I will have to use the local pharmacy and the local pharmacy will have no way of knowing what other medications I am taking unless I have all of my prescriptions filled in one location. As you are well aware, drug interactions create major problems every day. I would be very interested in knowing how you advise your customers to handle this situation.

  32. Robert Starkeyon 02 Feb 2013 at 4:22 pm

    When MOAA mentions “TRICARE” please indicate which form the information applies to….(Standard, Prime, or For Life, etc……)

  33. Susan H. Retzlaffon 02 Feb 2013 at 4:37 pm

    I have been using the mail order pharmacy (Express Scripts) for my maintenance meds since my husband died in 2002. No problems with delivery and my Doctor and Nurse Practitioner are happy to e-mail the ‘scripts to Express Scripts. I do have one maintenance medicince which I pick up at my Kroger pharmacy (ceterizine for allergies) which has not been available at Express Scripts. It is given to me free because of it’s unavailibility at E.S.

    I am very pleased with this mail order service. The doctor writes the prescriptions to be refilled automatically in 90 days and it always arrives right on time. If I am traveling and know that I won’t be home to receive the medicine or need it earlier to take with me, I can e-mail Express Scripts or call them and they will take care of it for me. Nothing could be easier.

    If others who are holding out for local pharmacy pick-up would try Express Scripts for maintenance meds, it would cost less and help all of us.

  34. CAPT Kathryn M. Beasley, USN.Ret.on 03 Feb 2013 at 6:33 am

    Chris,
    Thank you for describing your mother’s situation. There are many others like her.
    With respect to ESI and them not knowing about the new requirement – this has just been approved by Congress and it will take awhile to get through the system to become established and implemented. In other words it becomes a modification to the current government contract with ESI. This has not happened yet.
    There is a lengthy timeline associated with this and we will keep you up to date as we understand information.

  35. CAPT Kathryn M. Beasley, USN.Ret.on 03 Feb 2013 at 6:36 am

    All specialty drugs, as I suspect your husband is on several, will be exempt from the home delivery. There will be a detailed list and criteria put out by ESI and DoD. We understand at the outset though that there will be MANY exemptions within the specialty drug area.

  36. CAPT Kathryn M. Beasley, USN.Ret.on 03 Feb 2013 at 6:37 am

    You always have the option to switch to the Military Treatment Facility’s pharmacy for your prescriptions.

  37. CAPT Kathryn M. Beasley, USN.Ret.on 03 Feb 2013 at 6:41 am

    Royce,
    There will be certain criteria clearly established as to what is and what is not a maintenance medication. These will be part of the implementation of the program and we will assume to be widely published.

    As to the initial start of the mail order med, they have stated that there will be a portion of the script which can be filled immediately at the local pharmacy to “bridge” you into getting your medication established in the home delivery program.
    Again more to come as this program rolls out in the months ahead.

  38. Raymond McCleanon 03 Feb 2013 at 7:38 am

    Did anyone notice the fact that these are increases of 42% to 48%? If your $100 grocery bill goes up 45% your groceries will cost you $45 more. Gasoline, which is $3.37 a gallon would go to $4.88, Car insurance of $500 every 6 month would now be $725. The percentage increases on medication co-pay by TRICARE are ludicrous. It would be somewhat easier to swallow if those were 25% (which is still high). Meaning, $12 is now $15 and $25 increases to $31. I have no idea how many Rxs are filled but it is in the millions. If Express Scripts sales were $500,000,000 they will now be $725,000,000. Not a bad bonus for a year. Just a hard pill to swallow (pardon the pun).
    R R McClean Col USAF MSC Ret (Reg Pharmacist)

  39. Robert Pearsonon 04 Feb 2013 at 3:08 pm

    I got a new Rx for me Dec 27, 2012, it has several refills authorized. I need some more very soon. Do I got back to the pharmacy where I got it (it is not on the nearby MTF formulary) for a refill, or do I call Express Scripts and see if they can somehow transfer the Rx to their system, or do I need to ask my doctor for a new Rx for Express Scripts?
    I have been using Express scripts for several years for both my wife and myself for meds not on the nearby MTF, and it has worked well, but I seem to remember when we transferred from pharmacy to ES we needed a new Rx.
    Your advice will be very much appreciated.
    Chaplain Bob Pearson, LTC, USA, Retired

  40. Col. Steve Strobridge, USAF-Ret.on 04 Feb 2013 at 3:12 pm

    If the prescription you have is for a three-month supply and still has refills available, it can be transferred to the mail-order system. If not, you’ll need to obtain a new three-month, refillable prescription and provide that to ES.

  41. David Guithon 04 Feb 2013 at 4:42 pm

    Yes, the lesser of two evils is a great deal. Want both legs removed, or both arms? Oh, both legs would be fine because my arms are more beneficial. Rather have $100 copays or $50? MOAA jumps head first at the $50 because it is a better deal. I’d love to negotiate with you guys.

  42. Col. Steve Strobridge, USAF-Ret.on 04 Feb 2013 at 5:26 pm

    Nobody said it’s a “great deal.” it was, in fact, the lesser of two evils. Negotiating time is pretty much over when the House and Senate have both passed different size copay increases. It’s then a choice between what the House passed or what the Senate passed or something in between the two. Maintaining the status quo was no longer an option. If MOAA had said “we reject both”, you would have ended up with the worst evil. No legislator is going to try to help stave off the worst case scenario if you oppose their efforts do that. There comes a point where you have to take the best option left on the table — or you get stuck with the worst deal. 97% of beneficiaries understood that.

  43. Chester A. Banachowskion 04 Feb 2013 at 8:47 pm

    How is Tricare addressing the delivery for maintenance meds that are temperature sensitive, in the Phoenix area? Putting them in a styrofoam container, carried around many hours in a US Postal vehicle with the doors open to the 100+degree outside air in the extended “summer” season, before being delivered to a centralized mail kiosk for all the neighborhood, and not allowed to exceed 70 degrees F without losing its potency” doesn’t seem like its going to work. It sure didn’t when we tried this with civilian coverage.
    I would think that this instance would be one that merits a waiver. If that is allowable, how does one apply for a waiver?

  44. Norman S. Stahlon 05 Feb 2013 at 1:52 am

    RE: Mandatory Mail Order RX

    The goal of increasing use of the mail order pharmacy should be accomplished by increasing the retail vs mail order price differential and leaving the decision as to which option to use up to the patient.

    The mandatory mail order plan is potentially life threatening. I get most of my medications through express scripts mail order. I have had several occasions where my express scripts prescriptions have taken more than a month (after shipment) to get to my home – USPS failures – not express scripts fault for sure, but nevertheless, I had to go without medications for more than a week. For most prescriptions, I can grin and bear it, but for my emergency asthma inhaler, *I need it when I need it!* Angina patients probably feel the same about their meds.

    I like saving money and will use mail order for most things, but some medications are worth the additional expense!

  45. Col. Steve Strobridge, USAF-Ret.on 05 Feb 2013 at 9:10 am

    We’ve had extensive discussions with ESI on the exposure to heat issue. They have many customers in AZ and other hot areas, and say it’s not a problem in the vast majority of cases. They say the issue of losing potency above 70 degrees is one of long-term storage, not one of normal (or even greater-than-normal) delivery times, and that sitting in a vehicle on delivery routes or in a hot mail box until pickup will not affect potency for the vast majority of medications. In those cases when it could, they provide insulated delivery packaging.

  46. COL D.C. Warren-on 06 Feb 2013 at 4:03 pm

    The mail order pharmacy is OK for generic maintenance meds, if you are certain of what you are taking. I began using it when it became obvious it was to be required; my principal objection (as a physician) is thst the scrips in mail order pharmacies are usually filled by technicians, and ‘checked’ by a pharmacist (about whom I know nothing). There is no responsible pharmacist’s name on the bottle. My advice is to know what your pills look like, and check them when they arrive.

  47. D. L. Terryon 06 Feb 2013 at 6:23 pm

    Let me remind Col Stro that the lesser of two evils is still evil. Most
    of us were taught and trained to do the right thing and do completed staff work. One size does not fit all. No exclusions for old folk (65 or older) with the start of dementia or those w/o computers, etc

    My wife and I are 75 yrs old and have previously used ES for many years. However, since my wife has severe scoliosis (exteme double curves of her spine) and is home bound with almost no mobility and is in constant pain….she is in a pain mgmt program that is difficult to manage locally, let alone by US Mail. Must call for prescription from Dr every 30 days–takes 2 days for Dr, carry to local pharmacy for filling takes 1 or 2 days. The window is 5 days. This process is controlled tightly by federal law w/penalties. Oh yeah, Martha is 100% diaabled and I am her caregiver 24/7 in our home with a helper 2 days a week. This is like assisted living or nursing home care, but not officially. And we pay copays every month because we need home care to work as long as we can. Her disease has caused many other problems and also require many more medications (about12). Try managing that w/ES.

    I called the Al Medicaid Agency to see if the poorest of our society could choose any local pharmacy for their medications. Their answer was YES! This DOD decision is bad policy and bad staff work. The retired military under this policy are worse off than our Medicaid brothers when it comes to prescription drugs. Check it out!

  48. Paul Foxon 06 Feb 2013 at 7:59 pm

    My wife and I get our prescriptions filled at the local Base Pharmacy so it is my understanding that we are exempt from useing the TFL Mandatory one year Mail Order Program. Is that true? A friend told me no, that I still had to use the MOP. Thanks for all you folks at MOAA do to keep us informed!!!!

  49. Maj. Peter McCue (RET)on 06 Feb 2013 at 8:56 pm

    Somewhere the “advanced math” being used confuses me. We get a 1.7% COLA; the increase in the price of medicines is supposed to be the same; but a $12 medicine now costs $17, a $9 medicine is now $13, a $25 medicine now costs $44.

    These “kids” and their new math need to go back to school and learn the old fashioned math. Perhaps our government might consider telling us the truth once in a while instead of trying to cram nonsense down our throats and telling us how good it tastes.

  50. Ray Morris Cdr USN RETon 06 Feb 2013 at 8:56 pm

    I am so happy to hear how my Government is so proud of the 22 years I “served” my country so they can happily “screw” me over every chance they get.

  51. Col. HAL D. HICHBORNon 06 Feb 2013 at 9:37 pm

    My wife and I have used the mail-order pharmacy for several years and count on it. She requires anti-biotics and maintenance medications. Mine are essentially maintenance prescriptions. Both of us count on the good service that TFL facilities provide How can we help the effort to retain the good prices and service?

  52. Kenneth Greenwoodon 07 Feb 2013 at 12:30 am

    My wife and I tried mail delivery when we were under BC/BS and found it to never work smoothly. Finally we went to a local drugist who looked out for us in terms of drug interaction. A local druggest is the only point where all the perscription come together. Our local pharmasist caught drug interaction on several ocaasions since if you are seeing more than one doctor they perscribe for the current issue and don’t know if the drug they use might interact with a drug prescribed by another Doctor.

    There is another issue beside drug interaction. All of this plan favors the large drug companies at the expense of the local druggist who is losing business.

  53. Col. Steve Strobridge, USAF-Ret.on 07 Feb 2013 at 9:07 am

    yes, it is true that you can continue getting refills at the base pharmacy.

  54. Don Keeneyon 07 Feb 2013 at 12:09 pm

    MOAA, you have thrown the over 65 gang under the bus and now you are going to reap the backlash, as you should. Your credibility on other issues are now suspect with me…..this mail order thing has been your baby from the outset and it was full of holes and questions from the get-go….the bottom line is that we should have a CHOICE…..like you do, on where we fill our prescriptions. Your initial survey on how happy EVERYONE was with mail order was laughable and far from scientific. All of the questions these good folks are now asking and faced with, should have been reviewed long ago before you jumped on the bandwagon for mail order. What you are NOT telling the good folks who have earned thier benfits is that the year requirement could and probably will become a permanent thing.

  55. CAPT Henry Baldridge, USN (Ret.)on 07 Feb 2013 at 12:23 pm

    Setting up and using such a mail order account (either online or by phone) will be well beyond the mental and/or physical capabilities of many many very elderly, disabled and/or otherwise handicapped TRICARE beneficiaries who now very successfully use local retail pharmacies.

    Clearly, many very elderly/handicapped beneficiaries are not computer literate and also will have great difficulty interpreting and effectively following written instructions.

    There are unknown numbers of individuals who are sufficiently infirm to require care provided at home by private duty CNAs. Exemption of such individuals who are cared for in their homes by professionals is as justified as it is for residents of nursing homes.

    In preparing new regulations, to not provide exemption for individuals who are either physically or mentally incapable of using the mail order program will in effect deny to them this benefit earned by many years of military service. It would be patently unfair to collect greater TRICARE savings from the most elderly of retirees (i.e., WWII and/or Vietnam).

    It is respectfully suggested that beneficiaries who are either sufficiently infirm and those above a specified advanced age (i.e., 80 or 85 years) be exempted from the upcoming requirement to change to the mail order program when they are now successfully receiving their maintenance medications from local retail pharmacies where they can easily consult regularly with pharmacists who are familiar with their medical history.

  56. CAPT Kathryn M. Beasley, USN.Ret.on 07 Feb 2013 at 1:31 pm

    Henry,

    Thanks for your thoughts on this group of seniors, and there are many such as in the scenarios you describe. Many may have physical disabilities and cognitve impairiments which would preclude them from effective participation.

    We are intending to work with DoD to help design the criteria for exemption from the mandatory program. I suspect, as you have outlined, that those who are not able will be part of the exemption. Now what exact criteria or documentation will be required? It is still too early in the process for us to predict.

    Stay tuned we will keep our members posted!

  57. Art Catulloon 07 Feb 2013 at 3:46 pm

    So, my co-pays under TFL and “home delivery” from Express Scripts
    is only one dollar less than going to my corner drug store or Walmart for instance?? Where is the savings there — watching and waiting for 7-10 days to see if your prescription actually makes it through the US Mail, especiallly with no Saturday deliveries starting soon. What a benefit we got!!!

  58. CAPT Kathryn M. Beasley, USN.Ret.on 07 Feb 2013 at 4:03 pm

    Great question and this is often misunderstood.
    The benefit is refleccted in your up to a 90-day fill through the Tricare Home Delivery Pharmacy benefit; whereas, you receive up to a 30-day fill though the Tricare Retail Network Pharmacy. Thus, the benefit is a savings of not just a dollar but $89. Hope this helps!

  59. Jimmy Wryeon 07 Feb 2013 at 11:46 pm

    I have been using mail-order with Express Scripts for a very long time and I am overly satisfied with them. I have never had a problem with this service, they are also willing to contact your Doctor for refill orders. It is so simple to use.

  60. Mary Garretton 08 Feb 2013 at 3:38 pm

    I have two prescriptions that are classified narcotic medications from the Tricare Mail Order Pharmacy. These drugs cannot be refilled, and and can only be filled for a 30 day period, after which a new prescription must be then submitted. Furthemore, prescriptions for narcotics cannot be faxed or electronically submitted to TMOP and must instead be mailed. Given the uncertainties of the mail and the TMOP processing, it is impossible to be able to rely on delivery before the medication at home is empty. I had Mail Order for these drugs for some time and often went several days without my medications. Thus, I also have had to rely on a local retail pharmacy and hope there will be an exemption from the one year trial of using the TMOP for narcotic medications

  61. Maj.James P. Connell (ret.)on 08 Feb 2013 at 4:18 pm

    I am still confused abouit the benefits to be realised by this method of delivery. my meds and my wifes ( ages 69 and 67) can now be easily coordinated by our civilian retail pharmacy (CVS) when we move from our Cincinnati home to our condo in Sarasota and later return. The mail forwarding system in use by the UPS involves requesting mail forwarding every six months in which all First Class mail is collected at the Post Office servicing our “home” address. Roughly once per week all mail addressed to us there is collected and shipped to another central facility in Michigan and is then sent to our forwarding address in Sarasota. The result is that we are receiving our mail three weeks or more after it is sent to our Cincinnati address.
    Add to that the fact both of us are regularly using “controlled” medications; Xanax for my wife, and for myself, Avonex, a drug requiring refrigeration. I have little trust the Postal system can get the meds delivered to us on time and in good condition. On top of all that we will have a new requirement to have our doctors fill out whatever new paperwork will be demanded by the new system and re-do it all each time we switch our residence.
    This is scarcely a better use of scarce resources.

    Jim Connell

  62. Col. Steve Strobridge, USAF-Ret.on 08 Feb 2013 at 4:26 pm

    Mail-order isn’t applicable to medications that can’t be refilled. In any event, narcotics will be exempt from the mail-order requirement.

  63. GT Coleon 08 Feb 2013 at 5:31 pm

    Will Chapter 61 retirees be subject to co pay fee increases? If so, is this not decreasing still further the purchasing power of the service members disability compensation?

    I have used Express Scripts Mail Order for more than 6 years. I find them to be very reliable. I have used the VA but find their system to be slow, inconvinent and impersonable.

  64. George Kolesaron 09 Feb 2013 at 12:07 pm

    This is a great discussion. My compliments to MOAA for setting this up.

    My wife and I have used Express Scripts for several years now. After a wobbly start, ESI’s service has been outstanding. Both my wife and I are blessed with quite a long list of medications and ESI has kept them coordinated and delivered in a timely manner. I urge all retirees to give it a try. The convenience and savings are evident after you’ve experienced it.

    However …

    Some of my medications require refrigeration, including insulin. I presently receive one refrigerated medication (an eye drop) from ESI. It arrives in a rather large styrofoam container with cold packs inside. USPS leaves it on my doorstep. If I’ve been out for the day, this is not a problem, but, I wonder what would happen if I were on vacation for a week or longer in the Florida heat. Would someone help himself to the package if it were left on the doorstep? As a result, I have refused to have ESI handle my insulin; I get it from the local pharmacy instead and pay the extra cost.

    Will insulin be exempted from the mandatory maintenance drug rule?

  65. CAPT Kathryn M. Beasley, USN.Ret.on 09 Feb 2013 at 5:07 pm

    Thanks for your comments and question George.

    Insulin is considered a “specialty drug” by ESI and they have certain requirements and criteria for these medications.

    Having talked to ESI this week about these classes of medications, it is unclear yet which of them may or may not be included in the mandatory program. I can’t say at this point if your insulin injectables will be included in the program. There will be some specialty drugs which will but we have no details yet.

    When we have more information we will put that out….on another note, glad you are pleased with the home delivery services provided to you.

  66. Roger D. Hanelineon 10 Feb 2013 at 4:02 pm

    The Q&A is helpful—it would be even more useful IF the MOAA response was immediately under the member’s comments. There were several where the response was a few comments below the comment being responded to.
    My submission was rejected because I did not provide an email address. Your three possible information entries do not specify an email address.

  67. Ken Shuckon 10 Feb 2013 at 4:09 pm

    I get my prescriptions from a local pharmacy because I have been told that I can not use the Tricare mail order pharmacy option since I have other health insurance that I get thru my Federal retirement that pays first for my medicine, with Tricare paying what is left of the cost. I am on TFL.

    With this push to mandate using the Tricare mail order option instead of local pharmacies, will Tricare no longer cover any part of the cost of my medicines if I get them from the local pharmacy where my Federal Health Plan covers some of it?

  68. CAPT Kathryn M. Beasley, USN.Ret.on 11 Feb 2013 at 8:26 am

    Thanks for your question Ken.

    We don’t have an answer for this at this time but will be sure to bring it up for consideration in our discussions with DoD in the weeks and months ahead.

    Stay tuned!

  69. Col. Steve Strobridge, USAF-Ret.on 17 Feb 2013 at 7:26 am

    We had a temporary glitch in the comment system. Hopefully it’fixed now.