Health & Safety

April 28, 2017
 

Ask the Doc

99th Medical Group

Q. Are CVS and Target pharmacies part of TRICARE’s retail network?

A. No. If you get your prescription filled at a CVS or Target pharmacy you will pay for the full cost upfront and have to file a claim for partial reimbursement after you meet your deductible. Visit the costs page for details.

Prescription Costs
Your prescription costs depend on who you are, where you fill your prescription and the type of drug.

Active Duty Service Members
You can get prescriptions filled from any pharmacy at no cost.
• You may be required to pay up front for prescriptions from network and non-network pharmacies.
• You’ll get a full reimbursement when you file a claim with Express Scripts.
• Your provider must establish medical necessity for you to get non-formulary drugs A drug in a therapeutic class that isn’t as clinically or cost-effective as other drugs in the same class. You pay a higher cost share for these drugs. at no cost.

All Other Beneficiaries
Military Pharmacy
• Get up to a 90-day supply of most prescription drugs.
• $0 copayment

Home Delivery
• Get up to a 90-day supply of most prescription drugs.
• Generic formulary: $0
• Brand name formulary: $20
• Non-formulary: $49 (unless you get medical necessity)

Network Pharmacy
• Get up to a 30-day supply of most prescription drugs.
• Generic formulary: $10
• Brand name formulary: $24
• Non-formulary: $50 (unless you get medical necessity)

If you want a 90-day supply from your network pharmacy, you’ll pay the cost for each 30-day supply. For example, a 90-day supply of a generic drug will cost $30.

• Some non-formulary drugs are only covered through Home Delivery. Check with Express Scripts before filling prescriptions for non-formulary drugs at a retail network pharmacy.

Non-Network Pharmacy
You’ll pay more to get your prescription filled at non-network and overseas retail pharmacies.

• The costs are based on where you are, who you are and in some cases, what plan you’re using
• You may need to pay up front and file a claim for reimbursement.

Non-Network Pharmacies in the United States and U.S. TerritoriesWho You Are What You PayActive Duty Service MembersYou will get a full reimbursement. All Other BeneficiariesIf enrolled in a Prime plan, you pay 50 percent cost-share after point-of-service.

For all other plans, you pay:
• Formulary drugs: $24 or 20 percent of total cost, whichever is more, after you meet your annual deductible
• Non-formulary drugs: $50 or 20 percent of total cost, whichever is more, after you meet your annual deductible 1Includes activatedCalled or ordered to active duty service for more than 30 days in a row. Guard/Reserve Members

Non-Network (Overseas Retail2) Pharmacies in all other Overseas AreasWho You Are What You PayAll Beneficiaries Enrolled in a TRICARE Prime Overseas PlanYou will get a full reimbursement when you file your claimActive Duty Family Members using TRICARE Standard Overseas & Beneficiaries Using TRICARE Reserve Select20 percent cost share after you meet your annual deductibleAll Other Beneficiaries25 percent cost share after you meet your annual deductible.
 
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