Health & Safety

December 12, 2013

Ask the Doc

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Q. What’s my copay for a prescription I get at a non-network pharmacy?

A.TRICARE Pharmacy Copays or Cost-shares in the United States, Including American Samoa, Guam, Puerto Rico, the Northern Mariana Islands and the U.S. Virgin Islands.
Options include utilizing a Non-Network Pharmacy or a Host Nation Pharmacy.
A Non-network Pharmacy can provide up to a 30-day supply but be aware that you may have to pay the full amount up-front and file a claim to get partial reimbursement. If you’re an active duty service member, you’ll get a full reimbursement.
For Non-network Pharmacies TRICARE Prime option enrollees, including the U.S. Family Health Plan and TRICARE Young Adult-Prime option is 50 percent cost-share after you meet the Point-of-Service deductible of $300 per person and $600 per family. For all others the cost is $17 or 20 percent of the total cost, whichever is greater. The deductible for grades E1 to E4: is $50 per person and $100 per family. All others, including retirees are $150 per person and $300 per family.
A Host Nation Pharmacy can provide up to a 30-day supply and you may have to pay the full amount up-front and file a claim.
Active duty service members and active duty family members enrolled in a TRICARE Overseas Program Prime option will get full reimbursement after a claim is filed.
Active duty family members not enrolled in a TRICARE Overseas Program Prime option will receive a 20 percent cost-share after they meet their annual deductible. For the grades E-1 through E-4 the deductible is $50 per person and $100 per family. For the grades of E-5 and above the deductible is $150 per person and $300 per family. All others get a 25 percent cost-share after they meet their annual deductible of $150 per person and $300 per family.
If you live in the Philippines, you must get your medications from a TRICARE-certified pharmacy.

Send your questions to askthedoc@nellis.af.mil.




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