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Tricare Senior Pharmacy (TSRx) Department of Defense prescription drug program for senior retired personnel, their dependents and survivors |
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Tricare Senior Pharmacy (TSRx) Department of Defense prescription drug program for senior retired personnel, their dependents and survivors |
Under the provisions of the "TRICARE Senior Pharmacy (TSRx)" MEDICARE-eligible beneficiaries may obtain pharmaceuticals from four sources:
To ensure effective participation in both Tricare-for-Life and the Prescription Drug Program, each retiree or survivor must ensure that his or her name, address, social security number, service affiliation, effective date and eligible dependents, are properly recorded in the DoD DEERS system. If you are not registered in DEERS, you will not be eligible to participate in these programs. To review procedures for updating or verifying your DEERS information click here.
A toll-free telephone line has been established by DoD to answer questions retirees may have about the Tricare Senior Pharmacy (TSRx) benefit. The DoD call center at 1-877-DoD-MEDS (1-877-363-6337) is operational from 7 a.m. to 11 p.m. Monday through Friday , Eastern Time (except holidays). Questions about the Tricare Mail-order Pharmacy (TMOP) may be be directed to Express Scripts, Inc. at 1-866-DoD-TMOP (1-866-363-8667). Questions about the Tricare Retail Network Pharmacies (TRRx) may also be directed to Express Scripts, Inc. at 1-866-DoD-TRRx (1-866-363-8779)
General: If you have pharmacy benefit coverage under some other health insurance (or “double coverage” as it is sometimes called), you must use up your other insurance’s pharmacy benefit before you may use the Tricare prescription benefit in either retail pharmacies or the mail order program. Medicare HMOs, the Federal Employees Health Benefits Program (FEHBP), and any Medigap supplemental insurance plans that include a pharmacy benefit fall into this category.
Under the double coverage rules, the other insurance will be the primary payer, and Tricare will be the secondary payer. This isn’t a new rule. The law has stated for some time that Tricare must be second payer to other insurance coverage. This doesn’t just apply to pharmacy benefits, but to medical or surgical services, as well. The reason is that Congress did not want private insurance carriers reaping “windfall profits” by collecting premiums for services they wouldn’t have to pay for.
If OHI Coverage is Exhausted:
Once other insurance benefits have been used up each year, the DoD Pharmacy Program will pay the applicable pharmacy costs (less the applicable copayments), for the remainder of the year. To do so, beneficiaries will have to provide proof showing that OHI limits have been reached or exceeded. The Tricare Pharmacy Program will also provide a benefit if the medication is not on the formulary (list of available medications) for your other insurance, but is on the DoD formulary. But you will need to provide documentation that the drug was not on the OHI formulary. For Tricare retail pharmacy services, you can submit an Explanation of Benefits (EOB) statement or similar document from your other insurance carrier to a Tricare claims payer for your region. For the Tricare Mail Order Pharmacy (TMOP) program, you can send this documentation along with your co-payment and prescription. For instructions on how to use the TMOP program after your OHI benefit has been exhausted, call 1-866-DOD-TMOP (1-866-363-8667).If OHI Pharmacy Copayments are Larger than TSRx Copays:
DoD indicates beneficiaries with other health insurance pharmacy coverage may be eligible for partial reimbursement for the copays charged by their other insurance. Although definitive procedures have not as yet been established, beneficiaries should be able to submit a copy of their pharmacy receipt (showing the cost of the medication and the copay paid for the other insurance) to the TRICARE claims processor for their region. After the beneficiary has met any applicable annual TRICARE deductible, DoD may refund the difference between that copayment amount and the copayment the beneficiary would have paid under the DoD program.More information is available through the DoD Pharmacy Call Center at 1-877-DoD-MEDS (1-877-363-6337).