Do you need to get a new prescription? Or maybe you’ve been taking the same medication for years. To get your medications cheaply, it’s helpful to know some key terms.
“Your medical needs and health insurance plan will affect how much you pay at the pharmacy,” said Air Force Lt. Col. Leecraft A. Shakes, TRICARE pharmacy contract support chief for the Defense Health Agency. “It’s important to understand how TRICARE covers different types of medications so you can be sure you’re getting what you need at a fair price.”
Let’s start with this list of keywords.
Prescription medications Drugs covered by TRICARE. Widely available. There are two categories:
- Generic drugs
- Brand Name Prescription Drugs
Generic drugs covered by the TRICARE pharmacy benefit are just as effective as brand-name drugs. They provide the same treatment at a lower cost. TRICARE will generally fill your prescriptions with generic equivalents of drugs, when available.
Want to know what drugs TRICARE covers? TRICARE Prescription Search Tool A tool you can use to learn more about your prescriptions. It includes the following information:
- Coverage and out-of-pocket expenses
- Pharmacy Forms
- Prescription filling options
Drugs not covered by TRICARE Medicines not covered by insuranceIf TRICARE doesn’t cover the drug, ask your provider about a similar prescription drug, or you’ll end up paying the full price. Submit a claim To receive reimbursement, you must pay any applicable cost sharing, co-payments, deductibles, and other fees.
Eligible non-prescription drugs are those that may be priced higher than other drugs in the same treatment class. They are all available below. TRICARE Pharmacy Delivery Additional charges apply.
These are not typically available at military pharmacies. However, you can ask your local military pharmacy if they have them in stock. Also, most of these medications are TRICARE Retail Network Pharmacy.
Your healthcare provider may prescribe you a medication that is not on your formulary if they determine it is medically necessary. If you are not sure if this applies to you, ask your healthcare provider for more information.
Want to know the prescription status of your medication? TRICARE Prescription Search Tool.
Specialty Medicines Treat complex chronic diseases; Often require special storage and handling; Not widely available in pharmacies; These medications have side effects and dosing schedules that must be monitored by a health care provider.
Notes: Specialty medications are usually more expensive than generic or brand-name drugs. TRICARE Specialty Medicines.
Maintenance medications Treating chronic conditions, such as medicines to control blood pressure or cholesterol, taken regularly over a long period of time.
Out of medication? Getting a refill is easy, but it’s important to know the difference between a refill and a renewal.
a Refill This means that when your stock of a medication is low, you can order new medication. In this case, you don’t have to go through your provider to get new medication. Instead, MHS GENESIS Patient Portal Request refills from military pharmacies.
Are you trying to refill your prescription at a TRICARE retail network pharmacy? If so, check with your pharmacy for more information. Some drugs not listed on your prescription may be refilled at your pharmacy. TRICARE Pharmacy Delivery Or a military pharmacy.
Have you used up all your prescription refills? You need to get a new prescription for the same medication. This means contacting your healthcare provider to RenewalYou can do this at the scheduled time.
To request an update, MHS GENESIS Patient Portal. (Notes: In some cases, you may need to see a healthcare provider first.
Knowing pharmacy terminology and options can help you stay healthy and manage your out-of-pocket expenses. For more information, TRICARE Pharmacy Program or TRICARE Pharmacy Program Overview Fact Sheet.
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