Easy methods to Use TRICARE and Different Well being Insurance coverage on the Pharmacy > TRICARE Newsroom > Articles

Easy methods to Use TRICARE and Different Well being Insurance coverage on the Pharmacy > TRICARE Newsroom > Articles

Do you will have different pharmacy protection along with the TRICARE Pharmacy Program? Possibly you will have protection by way of your employer or a personal plan that you simply’ve bought. TRICARE calls this different medical insurance (OHI). Some OHI features a prescription drug profit that can be utilized with TRICARE. Studying extra about OHI and TRICARE pharmacy advantages can prevent money and time.
“In case your OHI features a prescription plan, there are a number of necessary issues to find out about how the 2 plans work collectively,” mentioned U.S. Public Well being Service Cmdr. Teisha Robertson, a pharmacist with the Protection Well being Company’s Pharmacy Operations Division. “Making the precise decisions with OHI and your TRICARE pharmacy profit can assist you pay decrease prices, each up entrance and in complete.”
Easy methods to report your OHI
It’s necessary that you simply share different medical insurance you carry along with TRICARE with the pharmacy contractor, Categorical Scripts. For those who don’t disclose this data, chances are you’ll expertise delays or issues when processing your prescription claims. To keep away from these points, inform Categorical Scripts you will have OHI with pharmacy advantages. Full a TRICARE Different Well being Insurance coverage (OHI) Kind and mail it to Categorical Scripts. It’s possible you’ll want to achieve out to your different insurance coverage firm to get some required data to fill out the shape.
Do you will have a supplemental or low cost prescription drug program? These don’t rely as OHI pharmacy protection. For those who don’t know when you have OHI, you may evaluate examples of sorts of protection on the Categorical Scripts web site.    
Easy methods to decrease your prices when you will have OHI
When you have OHI, it doesn’t stop you from utilizing your TRICARE pharmacy profit. When you will have OHI with pharmacy advantages, your OHI pays first and TRICARE pays second. You possibly can keep away from greater prices by getting your prescriptions crammed at a pharmacy situated in each your OHI community and the TRICARE retail community.  
Whenever you fill a prescription at a community pharmacy, inform your pharmacist you will have TRICARE protection along with your OHI. Your pharmacist can electronically submit your prescription to each plans on the similar time. Letting your pharmacist know you will have two prescription plans means:

  • Minimal out-of-pocket bills for you
  • By no means paying greater than the TRICARE copayment
  • No have to submit paper claims
  • Decreased or eradicated up-front prices

Easy methods to get reimbursement for prescriptions
You possibly can file a declare with TRICARE for reimbursement in case you meet one of many following necessities:

  • The pharmacy in your OHI community isn’t a TRICARE retail community pharmacy
  • You’ve exceeded the greenback restrict on your OHI
  • The drug isn’t coated by your OHI

To file a declare, fill out the Affected person’s Request for Medical Cost type (DD Kind 2642). And mail the shape, alongside along with your OHI clarification of advantages and your pharmacy receipt to Categorical Scripts. You should file your declare with TRICARE inside one yr from the date your prescription was crammed. Keep in mind to maintain your receipts. You should additionally print your OHI clarification of advantages. An evidence of advantages is an itemized assertion that reveals what motion your insurance coverage supplier has taken in your claims. Submit your receipts and your OHI clarification of advantages collectively for reimbursement.
Easy methods to use TRICARE Pharmacy House Supply with OHI
As outlined within the TRICARE Pharmacy Program Handbook, you aren’t eligible to make use of TRICARE Pharmacy House Supply when you have OHI with a prescription plan. This contains the Medicare Half D prescription program. There are some exceptions, nevertheless.
You need to use house supply in case you meet one of many following necessities:

  • You’ve a supplemental pharmacy profit, which is managed by Categorical Scripts
  • Your OHI doesn’t embrace pharmacy advantages
  • The drug you want isn’t coated by your OHI
  • You’ve met your OHI’s profit cap (for instance, you’ve met your profit’s most protection restrict)

When you’ve met considered one of these necessities, chances are you’ll submit your prescription to TRICARE Pharmacy House Supply. In case your drug isn’t coated or in case you’ve met the OHI profit cap, you should additionally embrace your OHI clarification of advantages. When you have a supplemental pharmacy profit managed by Categorical Scripts, your advantages are robotically coordinated utilizing each your OHI and TRICARE. This implies you don’t must file a paper declare to coordinate your OHI and TRICARE pharmacy protection. Assessment particulars on easy methods to get began with house supply.
Obtain the TRICARE Pharmacy Program Handbook for extra details about OHI and your pharmacy advantages. It’s also possible to attain out to Categorical Scripts. Representatives can be found 24/7 to reply your questions.
Would you want the most recent TRICARE information despatched to you by e mail? Go to the TRICARE Subscriptions web page at the moment, and create your personalised profile to get profit updates, information, and extra.