TRICARE and You: Facts about Pharmacies

This blog is the most recent in a series helping members of the Coast Guard family understand how to use their TRICARE benefits. The blog series will continue every Monday, right here on Coast Guard All Hands.

Medicine, first aid and vitamins

Written by Cmdr. Paul Fawcett, Health, Safety and Work-Life Service Center

As part of your TRICARE medical benefit you have access to pharmacy services. How you use that benefit depends on beneficiary status, where you are assigned, and the medication you need. To help you navigate using your pharmacy benefit here are some guidelines.

Active Duty Coast Guard Members

If you are assigned to a unit with a clinic that has a pharmacist, you should receive your medication from your clinic pharmacy. If your clinic does not stock a particular item that you need, you may be referred out to a network pharmacy to fill your prescription. There should be no cost to you at any location. In the unusual situation you do pay upfront for a prescription at a network pharmacy, you can file a claim and will be fully reimbursed. Active duty Coast Guard members may also have their prescriptions filled at Department of Defense pharmacies or via the TRICARE Pharmacy Home Delivery program. The Pharmacy home delivery program is the most economical and easiest program for you and the Coast Guard.

If you are assigned to a unit that does not have a clinic with a pharmacy you must receive your prescriptions from either a DOD pharmacy, retail pharmacy or the TRICARE Pharmacy Home Delivery Program.

Most Over-the-Counter medications and supplements are not a covered TRICARE benefit.

Family members of Active Duty Members

Beginning October 1, 2015, a change in federal law requires you to refill prescriptions for select maintenance drugs through TRICARE Pharmacy Home Delivery or at a DOD military pharmacy. Maintenance drugs are those you take on a regular, ongoing basis for chronic, long-term conditions such as those used to control blood pressure. This does not include drugs your doctor prescribes for a short-term condition, such as antibiotics. Generic drugs through TRICARE Pharmacy Home Delivery list require no copay, brand name drugs require a $20 copay, non-formulary drugs require a $50 copay.

For short term medications on the TRICARE formulary, active duty family members may receive prescriptions at DOD pharmacies at no cost. You may also have your prescriptions filled at retail pharmacies. Currently, a 30 day supply of most generic prescriptions filled at retail pharmacies costs $10, brand name drugs cost $24.

Coast Guard Reserve Members

Drilling reservists who purchase the TRICARE reserve select are eligible for the pharmacy benefit and are subject to the same guidelines and receive the same benefit as their active duty counterparts.

Reservists on orders who seek care in a Coast Guard or DOD facility for an acute condition may have prescriptions filled at no cost during the duration of their orders or longer if covered by a notice of eligibility for a specific service related condition.

Reservists receive no pharmacy benefit when not on orders and have not purchased TRICARE coverage.

Retirees

Retirees are also required to have maintenance medications filled via TRICARE Pharmacy Home Delivery or at a DOD pharmacy or network retail pharmacy.

Currently, Coast Guard pharmacies are not able to provide services to military retirees due to safety issues related to changes in medical databases.

Pharmacy FAQs:ATC's medical facility

Q: How are Express Scripts and the TRICARE Mail Order Pharmacy benefit related?

A: Express Scripts is the provider of the TRICARE Mail Order Pharmacy.

Q: What’s a formulary?

A: A formulary is a list of standard medications authorized and contained in a pharmacy.

Q: How can I sign up for TRICARE Pharmacy Home Delivery?

A: Go to the TRICARE Pharmacy Program website or call 1-877-882-3335.

Q: How do I know what’s in the TRICARE formulary so I’ll know if I have to pay the higher non-formulary cost you mentioned?

A: Use the TRICARE formulary search tool to see.

Q: What’s a network pharmacy?

A: A network pharmacy is a retail pharmacy that accepts TRICARE.

Q: How do I know if my pharmacy is a network pharmacy?

A: Search for participating pharmacies

Do you have questions about the TRICARE benefit? Leave them in the comments below or send us an email SocialMedia@uscg.mil, and we will work to get your questions answered!

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