another tricare ?

saturdaynightdoubletree · September 2010

Are prescriptions really expensive with TriCare? I ended up taking DD to the ER yesterday, resulting in needing a prescription. Walmart called to say it was going to cost $37. With my old insurance I paid $12 tops for scripts. We still have a few months coverage left on our old insurance... should I just use that? We are not stationed on an actual base, therefore there are no military facilities in the area to go to for care and prescriptions. TIA

iluvmytxrgr · September 2010

No, rx are not expensive at all. You need to check with Walmart because they probably made a mistake. You should never have to pay more than $12. My grandma has a rx that would normally cost her $1200 a month. She pays $12 for it. I have never paid more than $8. Most of ours are usually $3 or $4.

GracieLou Freebush · September 2010

Does the pharmacy have your updated Tricare insurance info? Call and double check b/c your scripts should be cheaper than what they quoted you.

ckandi007 · September 2010

You can check on the Tricare website to see what drugs are covered...not all of them are. When I changed birth control pills years ago, the brand they put me on was not covered by Tricare for some reason. I ended up changing again to one that was--it could be just one of those brands.

JoBieger05 · September 2010

Every RX DH and I have gotten has been $3.00 each.

fmoore723 · September 2010

Here...if you take the RX on base---its free. Generics are $3 and Name brands are $9 at civilian pharmacies. Never came across a med that wasnt covered by Tricare (Im sure they exist somewhere though). Walmart should also have a $4 generics list that alot of commonly used meds are on---regardless of whether you have insurance or not.

saturdaynightdoubletree · September 2010

thanks ladies Smile

sorry for all the questions lately!

hoping4sticky · September 2010

My guess is that it is not covered. My AD husband had to get a prescription filled out in town because the base didn't have it and we had to pay over $30. I was surprised about that though.

Ilumine · September 2010

TRICARE FORMULARY COSTS

https://www.tricare.mil/mybenefit/ProfileFilter.do;jsessionid=MGJLWRyMKWy6cVsF6PsDJv6WHJytKJyTq2nhM4TQcvTykDlwgqg2!-69021903?puri=%2Fhome%2FPrescriptions%2FMedications%2FUniformFormulary

Free at the Base Pharmacy (if the pharmacy carries the script. If not, the can get it for you if deemed medically necessary.

Generics - $3

Formulary - $9

Non-Formulary (ie non preferred) - $22

These prices are for a 30-day supply (genearally) through retail and 90-day through the Mail Order Pharmacy program.

If you are prescribed a non-formulary script, you can get it deemed medically necessary and have the cost reduced to $9.

hilwithonelary · September 2010

Did WalMart have your Tricare info when they processed the prescription? All they need is a military ID to submit the claim to Tricare.

You can always use this website to check what your copay will be:

https://pec.ha.osd.mil/formulary_search.php

In general, you will pay $3 (generic), $9 (brand name when no generic is available, or $22 (non-formulary). Be aware that many meds that are available OTC are not covered.

hilwithonelary · September 2010

hoping4sticky:
My guess is that it is not covered. My AD husband had to get a prescription filled out in town because the base didn't have it and we had to pay over $30. I was surprised about that though.

Dependents and retirees should never have to pay more than $22 for a prescription only medication. AD members don't have this option. For them, if it falls in the $22 copay category (non-formulary), it is simply not covered at all. The med your husband was prescribed was either OTC (not covered for anyone) or non-formulary (not covered for AD)

Ilumine · September 2010

hilwithonelary:

hoping4sticky:
My guess is that it is not covered. My AD husband had to get a prescription filled out in town because the base didn't have it and we had to pay over $30. I was surprised about that though.

Dependents and retirees should never have to pay more than $22 for a prescription only medication. AD members don't have this option. For them, if it falls in the $22 copay category (non-formulary), it is simply not covered at all. The med your husband was prescribed was either OTC (not covered for anyone) or non-formulary (not covered for AD)

Actually AD servicemembers CAN get the Third Tier (Non-Formulary) drugs. They will have to follow the Step-Therapy system (ie try a formular/preferred drug first) but if deemed medically necessary, they will get it. If that were true, that would mean that the Servicmember would be denied hundreds of FDA approved medicines.

Now, if the script in question is not on the Basic Core Formulary of that particular MTF Pharmacy, and the pharmacy cannot get the script (there is a lot of paperwork, but you can force them to do it) the AD servicemember would have to go downtown like everyone else.

But as long as there is a waiver, he/she would be approved to get the drug AND at the $9 cost share.

hilwithonelary · September 2010

Ilumine:

Actually AD servicemembers CAN get the Third Tier (Non-Formulary) drugs. They will have to follow the Step-Therapy system (ie try a formular/preferred drug first) but if deemed medically necessary, they will get it. If that were true, that would mean that the Servicmember would be denied hundreds of FDA approved medicines.

Now, if the script in question is not on the Basic Core Formulary of that particular MTF Pharmacy, and the pharmacy cannot get the script (there is a lot of paperwork, but you can force them to do it) the AD servicemember would have to go downtown like everyone else.

But as long as there is a waiver, he/she would be approved to get the drug AND at the $9 cost share.

You are correct, except that if an AD member gets approved for a non-formulary med, there should be no copay, even at civilian pharmacies. I was simply not wishing to dive into the world of Medical Necessity forms. What I was trying to get across is that when some doctor an AD member got referred to (who has no idea what the Tricare formulary is) writes an Rx for Prevacid when the person has tried nothing else, it will not be covered. If that AD member takes that Rx to the pharmacy and hasn't met the medical necessity criteria, he/she can't pay $22 to get it. It would cost full price until the criteria are met.

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