Q. I am the widow of a 20-year Air Force retiree who is entitled to Tricare for Life. Recently I have been charged for some of my prescription medications. I have asked about this and have been told there are some drugs not covered by TFL. Can you tell me which ones are covered?
A. Under Tricare for Life, for health care services other than prescription drugs, Medicare acts as primary payer and Tricare Standard serves as a secondary backup payer. Each system has its own prescription drug plan; Medicare's is known as Part D.
However, Tricare officials say Tricare for Life beneficiaries usually see little or no benefit from enrolling in Medicare Part D; they simply don't need it, as Tricare's prescription drug plan functions in much the same way and covers much the same drugs.
Tricare's formulary is divided into three tiers. The first is generic drugs, the second brand-name drugs, and the third nonformulary drugs for which prescriptions can be filled, but at a higher cost to beneficiaries.
To see if a drug is included in the Tricare formulary, and which tier it's in, see the list online.
That's a simple search tool into which you can enter the name of any medication to see which tier it's in and what it costs. You can get more information on your prescription drug benefits by calling Tricare's pharmacy contractor, Express Scripts, at 877-363-1303.
You should also be aware that a pharmacy pilot program is underway for Tricare for Life beneficiaries that may affect you.
TFL beneficiaries who take certain long-term drugs and fill those prescriptions at a Tricare network retail pharmacy may have to participate in the pilot, which requires them to fill their prescriptions through home delivery or at a military pharmacy.
Drugs covered by the pilot are maintenance medications taken regularly for a chronic condition, such as high blood pressure or high cholesterol. Beneficiaries taking such drugs can find out of they must participate in the pilot by calling Express Scripts at the number above.
There is an online search tool that shows which maintenance drugs are covered by the pilot.
How the program works: When beneficiaries fill a prescription at a network retail pharmacy for a drug covered by the pilot, they'll get a letter from Express Scripts. They then must review their options for filling such prescriptions in the future, either through home delivery or a military installation pharmacy.
If beneficiaries fill that prescription a second time at a network retail pharmacy, they'll get another letter from Express Scripts about switching to home delivery.
If they fill that prescription a third time at a network retail pharmacy, they will have to pay 100 percent of the cost out of pocket.
After participating in the pilot for one year, beneficiaries may opt out. In certain circumstances, beneficiaries also can get a waiver from participating. Express Scripts can provide more information.
Email tricarehelp@militarytimes.com. Include the word "Tricare" in the subject line and do not attach files.
