TRICARE Law Requires Beneficiaries to use Military Pharmacy, Home Delivery

Story Number: NNS150909-03

Release Date: 9/9/2015

By Douglas H. Stutz, Naval Hospital Bremerton Public Affairs

BREMERTON, Wash. (NNS) -- There is an important change coming to the TRICARE Retail Pharmacy benefit that will impact all beneficiaries except active duty service members.

Naval Hospital Bremerton's pharmacy staff is ready to help.

Starting Oct. 1, 2015, federal law (the 2015 National Defense Authorization Act) will require that TRICARE beneficiaries who currently get select maintenance medication at a network pharmacy will have to switch those prescriptions to TRICARE Pharmacy Home Delivery or a military pharmacy.

Maintenance medications are those used for chronic, long term conditions taken on a regular recurring basis, such as used to control cholesterol or blood pressure. The law does not apply to drugs that are prescribed for short-term condition, such as antibiotics.

Beneficiaries can check www.Health.mil/SelectDrugList or call Express Scripts at 1-877-363-1303 to determine if their prescription medications are affected by the upcoming change.

Last year NHB filled approximately 509,130 outpatient prescriptions for nearly 31,000 TRICARE enrollees in the West Puget Sound area of the greater Kitsap Peninsula, and another 5,150 enrollees in the East Puget Area serviced by NHB's Branch Health Clinic Everett.

The impact is for the better, says Lt. Cmdr. Eric Parsons, NHB Pharmacy department head, citing that the NHB Pharmacy and the TRICARE Pharmacy Home Delivery are both excellent, money-saving alternatives for beneficiaries.

"We've been advocating the Home Delivery option for several years. It offers our TRICARE beneficiaries excellent care and service in addition to lower, out-of-pocket costs when compared to obtaining chronic maintenance medications from the retail network," said Parsons.

A beneficiary can save up to $240 a year for every brand name formulary medication ($96 per year for each generic formulary medication) moved to the secure and convenient TRICARE Pharmacy Home Delivery service. The TRICARE Pharmacy Savings Calculator on www.TRICARE.mil/pharmacy can help project how much can be saved by switching.

Parsons attests that Naval Hospital Bremerton has an extensive formulary of medications available for beneficiaries. Home Delivery is also an excellent option for TRICARE beneficiaries to get their maintenance medications, especially for those who live farther away from a military pharmacy.

"These choices are both less expensive than the TRICARE Retail network, and Home Delivery offers the convenience of having maintenance medications delivered directly to your home. A beneficiary will pay more to get their prescription filled at a non-network pharmacy, and they very well might need to pay up front and then file a claim for reimbursement," said Parsons, adding that if someone decides to try the Naval Hospital Bremerton or BHC Everett pharmacy, they can call ahead for a new prescription at 360-475-4425 to make sure their medication is available.

"We are available to assist," Parsons stressed.

NHB's formulary listing is also available online at http://www.med.navy.mil/sites/nhbrem/patients/Pages/pharmacy.aspx.

Beneficiaries who continue to get select maintenance drugs at a network pharmacy will pay 100 percent of the cost; this does not apply to active duty service members.

Patient costs vary based on where a beneficiary gets their prescription filled and the type of drug: generic, brand name or non-formulary. Beneficiaries can save on cost by asking their doctor to electronically-submit prescriptions for formulary medications to the NHB pharmacy for subsequent filling instead of to a network pharmacy.

A beneficiary must do one of the following to avoid paying 100 percent of the cost for medication:

Option One: transfer select maintenance drug(s) from a network pharmacy to a military pharmacy like Naval Hospital Bremerton or BHC Everett. Call the NHB pharmacy at 360-475-4425 to see if they carry your medication. If they do, ask your provider for a written prescription or send an electronic prescription to NHB Pharmacy for filling.

Option Two: transfer select maintenance drug(s) from a network pharmacy to TRICARE Pharmacy Home Delivery. This option is safe, convenient and costs less than a network pharmacy. To get started, call the Member Choice Center at 1.877.882.3335 or visit Express-Scripts.com/TRICARE.

Option Three: is for a beneficiary to have their network prescriber send an electronic prescription to the TRICARE Pharmacy Home Delivery Service. To get started, visit https://www.express-scripts.com/TRICARE/safety_savings/prescribing.shtml

Option Four: is for beneficiaries to ask their doctor about using a generic drug instead of a brand-name drug. Most generic drugs are still available at network pharmacies. Beneficiaries can get up to a 90-day supply of formulary generic medications at TRICARE Pharmacy Home Delivery at no cost.

For those who prefer to obtain select maintenance drugs(s) at a network pharmacy after October 1, 2015, they will receive a letter from Express Scripts reminding them of the new policy. For anyone who continues to get their select drugs at a network pharmacy, they will pay the full cost.

There will be a process to get a waiver due to personal need or hardship, emergency or other special circumstances, such as living in a nursing home. Express Scripts will consider waiver requests on a case-by-case basis. For those beneficiaries who have Other Health Insurance with a prescription benefit, they can continue using a network pharmacy.

Active duty service members, beneficiaries living overseas, and beneficiaries with other health insurance are not subject to this requirement.

For beneficiaries seen by civilian providers and in need to get a prescription filled, the electronic prescription - or e-prescribing - offers a perfect solution.

E-prescribing started at NHB in March, 2014, and other Military Treatment Facilities (MTFs) are now following suit to currently accept and fill prescriptions written outside MTFs from civilian providers.

"The process has been very well received by NHB patients, network providers, and pharmacy staff. This capability allows civilian providers to securely send their prescription and associated instructions electronically to Naval Hospital Bremerton for any of our NHB beneficiaries. Additionally, patients whose network provider utilizes eRx no longer have to worry about losing a paper prescription between obtaining it from the provider and delivering it to the pharmacy. Correct use of the eRx functionality offers near instantaneous transmission of the prescription information from the prescriber to pharmacy," Parsons said.

According to Parsons, the electronic prescription initiative is part of a Congressional mandate that centers on 'meaningful use' of the Electronic Healthcare Record (EHR) system.

"This initiative has helped civilian healthcare providers meet that standard by using the EHR for what's it's designed to do which is eliminate paperwork and electronically connect a provider with a pharmacy such as ours," explained Parsons, citing that if all hardcopy prescriptions were to be sent electronically, based on the past 365 days, that would be 47,375 prescriptions annually.

"We were so happy to find out that NHB was doing this. We love it. This is much more convenient for patients and much more cost efficient for providers," commented Ms. Laurie Kehler, Clinic supervisor at Harrison Medical Center, Bremerton, Wash.

Prior to implementation of the e-prescribing capability, if a beneficiary went to see a doctor outside of NHB and as part of the overall treatment had to pick up medication(s), the provider would have to hand write the prescription for the patient to then hand deliver to fill at the NHB Pharmacy.

"Receiving the prescription electronically helps to clarify the dosage, quantity, and actual medication, increasing patient safety. It also prevents the potential for losing a written prescription," stated Parsons, adding that once a script has been sent to NHB's Pharmacy, it can 'sit' for up to a year before being filled once the patient actually shows up to request the medication.

Parsons notes that once the initial electronic prescription has been sent, received and filled by NHB, future refills remaining on the prescription can then be simply phoned in by the beneficiary and picked up at the drive-through option if so desired.

The ideal-future state cites Parsons, is that all hard-copy requests for any prescription will become accomplished by electronic means.

However, the system is not set up to handle any controlled substances such as Percocet or Vicodin. All controlled substances must be via hand written prescription.

Parsons also stated e-prescribing is not only a secure method for transferring prescription data which means better accuracy, increased patient safety and less prescriptions lost or misplaced, but as the pharmacy staff has gotten used to processing the eRXs, the familiarity has translated into more timely processing of the prescription than the old method of transcribing a written script.

The electronic prescribing address for NHB's e-pharmacy is

DoD Bremerton ePhcy,

1 Boone RD Code 08RAZD,

Bremerton WA, 98312,

Phone: 360-475-4425,

Fax: 360-475-4786.