Changes to TRICARE pharmacy benefit outlined

A new law requires most TRICARE beneficiaries to get brand name maintenance drugs from TRICARE Pharmacy Home Delivery or a military pharmacy.

But that directive does not mean that TRICARE beneficiaries cannot use their local pharmacies.

Pharmacists Brett Bryan and Steve Shiver said that they have received questions from their clients who are TRICARE beneficiaries about a recent letter sent from Express Scripts Federal Pharmacy Services.

Bryan is owner of Bryan Pharmacy in Enterprise and Elba. Shiver is co-owner with Joel Ellis of Center Drugs in Enterprise and Daleville and Bryars-Warren Drug, in downtown Enterprise.

Both pharmacists said they are happy to clarify the issue for clients with questions. Bryan has a written clarification for clients. Shiver said his staff is answering questions as they come in.

In the Express Scripts letter, recipients are told that the new law, effective Oct. 1, does not apply to active duty service members, beneficiaries living overseas or those who have another insurance plan with prescription drug coverage

All other TRICARE beneficiaries are required to get brand name maintenance drugs from TRICARE Pharmacy Home Delivery or a military pharmacy. If beneficiaries keep using a retail pharmacy for these drugs, they will have to pay the full cost.

A press release from the pharmacy on Fort Rucker explains that maintenance drugs are defined as those a person takes regularly for a long time, such as drugs to control blood pressure or cholesterol. The law does not apply to drugs taken for a short time, such as antibiotics, nor does it apply to generic drugs.

The key phrase is “brand name,” according to Bryan and Shiver. “You can continue to receive all generic drugs as well as drugs for shorter-term needs at your local community pharmacy with no co-pay charges,” Bryan said. “Nearly 80 percent of all prescriptions are for generic medications and we are happy to cross-check the TRICARE list to see if your medications are impacted by this change.”

“Lyster Army Health Clinic Pharmacy and other military pharmacies are a great way to fill your maintenance and all other medications, since you can get up to a 90-day supply and there’s no cost for TRICARE beneficiaries,” said Lt. Col. Tai Bolaji, chief of Lyster pharmacy. “Contact the Lyster Pharmacy at 255-7178 to see if your prescription is available.”

“The TRICARE mail order pharmacy program is able to purchase brand name drugs at special government rates not available to retail pharmacies,” Bryan explained. “Given a choice, most people choose to use the much less expensive generic medications from their local pharmacy.”

TRICARE has offered the mail option for years but many military personnel and their families opt for the access and convenience of their local pharmacy, Bryan said. “Complaints with mail orders often are associated with the unpredictability and delays related to prescription delivery, the heat and cold that medications can be exposed to in the delivery process and being able to have a discussion with the pharmacist who filled their prescription.”

Bryan said that those who are not on one of the TRICARE specified brand name medications for a chronic condition do not need to make any changes. He recommended checking with your local pharmacist to see if there is a generic alternative. He also recommended calling Express Scripts at 1-877-363-1303 to request a waiver to continue to receive all medications at a local pharmacy.

According to the press release from the Lyster Pharmacy, Express Scripts will send another letter to beneficiaries who continue using a retail pharmacy for the designated drugs. After that, beneficiaries have one more chance to fill these prescriptions at a retail pharmacy before they have to pay 100 percent of the cost of their medication,

“We are here to make sure you get medications that are of the highest quality, safety and effectiveness,” Bryan said. “Our pharmacy appreciates the work of our service men and women in protecting our freedom.”