The Military Health System (MHS) is modernizing to better serve you and respond to changes in law and policy. Over the coming months and years, you will see some significant changes to the TRICARE health plan. Most provisions went into effect on January 1, 2018, with full implementation occurring on January 1, 2019. Here are the latest TRICARE updates that your family needs to know about:
As of Jan. 1, 2018, most TRICARE Prime enrollees no longer need a referral for urgent care visits and point-of-service charges no longer apply for urgent care claims.
This change replaces the previous policy, which waived referrals only for the first two urgent care visits per year.
Active duty service members (ADSMs) should continue to visit military hospitals and clinics for care. ADSMs enrolled in TRICARE Prime Remote who don’t live near a military hospital or clinic don’t need a referral when seeking an urgent care visit.
“We wanted our service members’ families and others to have easier access to urgent care,” said Ken Canestrini, acting director, TRICARE Health Plan within the Defense Health Agency. “Beneficiaries can go visit an urgent care center right away anytime they have a need.”
If you use TRICARE Select or any other TRICARE plan, you may visit any TRICARE-authorized provider. An authorized provider is any individual, institution/organization,
or supplier that is licensed by a state, accredited by national organization, or meets other standards of the medical community, and is certified to provide benefits under TRICARE. There are two types of TRICARE authorized providers: Network and Non-Network.
Urgent care is care you need for a non-emergency illness or injury requiring treatment within 24 hours. Examples of urgent care conditions include a sprain, rising temperature or sore throat. It isn’t an emergency and doesn’t threaten life, limb or eyesight.
If you’re unsure whether to seek urgent care, call the 24/7 Nurse Advice Line at 1-800-TRICARE (874-2273)—Option 1. You can speak with a registered nurse who can answer your questions and give advice. The nurse can also assist you with finding a provider and scheduling an appointment.
If you need care after hours, while traveling, or if your primary care manager is unavailable, urgent
care is a great option. Contact your regional contractor to help you find an appropriate urgent care facility or provider. You may also use the TRICARE provider search tool.
Any TRICARE Overseas Program Prime enrollees requiring urgent care while on temporary duty or on leave status in the 50 United States and the District of Columbia, may access urgent care without a referral or an authorization. However, the ADSMs must follow up with their primary care manager in accordance with applicable DoD and Service regulations concerning ADSM care outside military hospitals and clinics.
Pharmacy cost increases
As of February 1, 2018, copayments for prescription drugs at TRICARE Pharmacy Home Delivery and retail pharmacies increased. These changes are required by law and affects all TRICARE beneficiaries except activeduty service members, dependent survivors and medically retired service members and their dependents.
While retail pharmacy and home delivery copayments will increase, prescriptions filled at military pharmacies remain available at no cost. Patients can save the most money by filling prescriptions at military pharmacies.
“Military pharmacies and TRICARE Pharmacy Home Delivery will remain the lowest cost pharmacy option for TRICARE beneficiaries,” said U.S. Air Force Lt. Col. Ann McManis, Defense Health Agency Pharmacy Operations Division.
TRICARE groups pharmacy drugs into three categories: generic formulary, brand name formulary and non-formulary. Individuals pay the least for generic formulary drugs and the most for non-formulary drugs, regardless of whether they receive prescriptions via home delivery or a retail pharmacy.
Retail network pharmacy copayment changes (up to a 30-day supply)
- Generic formulary drugs increased from $10 to $11.
- Brand-name formulary drugs increased from $24 to $28.
- Non-formulary drugs increased from $50 to $53 (but, non-formulary drugs are generally only available through home delivery).
TRICARE pharmacy home delivery copayment changes (up to a 90-day supply)
- Generic formulary drugs increased from $0 to $7.
- Brand-name formulary drugs increased from $20 to $24.
- Non-formulary drugs increased from $50 to $53.
“Any patient who wishes to switch to the military treatment facility pharmacy from mail-order or offbase pharmacies must get a new prescription from their doctor,” said Maj. Rachel Copeland, 19th Medical Group Pharmacy Flight Commander. “We can’t accept transfers of prescriptions from either source (mail-order or off-base), so patients are encouraged to visit the military treatment facility pharmacy before running out of medicine.”
Copeland added that patients need to contact Express Scripts to cancel any future automatic refills for any prescription they want to receive from the military treatment facility.Read comments