TRICARE Medicinal Program

04 Sep TRICARE Medicinal Program

TRICARE’s Medicinal Program is available to all eligible enrolled TRICARE beneficiaries through the Defense Enrollment Eligibility Reporting System (DEERS).

TRICARE’s Medicinal Program is available to all eligible enrolled TRICARE beneficiaries through the Defense Enrollment Eligibility Reporting System (DEERS). This coverage is available worldwide and is applicable to any health plan option of your choice. TRICARE makes this medicinal coverage provision accessible to all military retirees, their family members, uniformed service members and beneficiaries age 65 and older.

The TRICARE medicinal coverage is the same for all health plan options and beneficiary categories upon enrollment to the program. However, some restrictions are applied to prescription filling in some overseas countries.

Beneficiaries who are eligible to apply for TRICARE medical coverage include:

• United States military members and their families
• Active members of the United States Reserve and National Guard and their families (check Title 10 or 32 under Government Orders)
• Service member retirees and their families
• Reserve and National Guard member retirees and their families (applies to those people ages 60 and older and are receiving retirement benefits)
• Widows/widowers, survivors, and specific ex-spouses
• Recipients of the Medal of Honor and their families
• TRICARE Reserve Select or Continued Health Care Benefit Program enrolled beneficiaries
• Beneficiaries listed in the Defense Enrollment Eligibility Reporting System (DEERS) are qualified to receive TRICARE coverage, including foreign military force members and their families

HOW PRESCRIPTIONS ARE FILLED

You can fill your prescription using one of the several options offered through TRICARE, depending on the specific needs of you and your family. More than one option may be suitable at a given time. The following options are available to choose from which may be based your location:

• MILITARY PHARMACIST: This is the cheapest option requiring no extra co-payments.

• MAIL ORDER PHARMACIES: This is an applicable when a military pharmacy location is not near you. It is convenient, safe and secure, and cost-effective.

• NETWORK PHARMACY RETAILERS: There are over 54,000 pharmacy retailers within the network within the United States and U.S. territories.

• OUT-OF-NETWORK PHARMACY RETAILERS: This option is the most expensive but is an option if necessary.

Note: Though most of these options are available worldwide to members living in other countries though  some may not be available outside of the United States.

Most of the medications approved by the United States Food and Drug Administration (FDA) are covered by TRICARE medicinal coverage. These drugs may be available as part of medical or pharmacy benefits.

Generally, for medicine to be covered under TRICARE it must meet the following requirements:

• Must be FDA-approved prescription medicine
• Must not be part of the medical benefit covered procedures
• The medicine must be prescribed according to established quality standards and medical practices

In addition, all medicine that is not psychologically or medically necessary for the treatment or diagnosis of ailments that are covered under TRICARE will not be included in the medicinal coverage. This also applies to prescribed medicines that are used to treat illnesses that are not curently covered by TRICARE, either by regulations or by law.

Some of these excluded medications are as follows:

• Medications prescribed for cosmetic use.
• Food supplements
• Supplements of fluoride
• Homeopathic medicinal practices as well as herbal medications
• Multivitamins
• Over-the-counter medication with the exception of diabetic and insulin supplies and medications covered by the over-the-counter Medication Demonstration Project
• Products for smoking cessation
• Products for weight loss
• Over-the-counter prenatal vitamins though TRICARE covers prenatal vitamins if they are prescribed

The classification of the prescriptions, as well as where you get your prescription filled, will determine the drug costs at each pharmacy. The classifications of prescriptions are Tier 1 (formulary generic), Tier 2 (formulary brand name), and Tier 3 (non-formulary).