Pharmacy benefits for Medicare-eligible beneficiaries

TRICARE beneficiaries who were entitled to Medicare Part A prior to April 1, 2001, remain eligible for TRICARE pharmacy benefits without the requirement to have Medicare Part B. Medicare-eligible beneficiaries are able to use the TRICARE Pharmacy Program if they are entitled to Medicare Part A and have Part B.

If they do not have Medicare Part B, they may only access pharmacy benefits at a military hospital or clinic. (Exceptions exist for certain beneficiaries, including ADSMs and ADFMs. Please see TRICARE For Life for more information.)

Medicare-eligible beneficiaries are also eligible for Medicare Part D prescription drug plans. However, beneficiaries do not need to enroll in a Medicare Part D plan to keep their TRICARE Pharmacy Program benefits.

Providers can direct eligible beneficiaries who inquire about Medicare Part D coverage to visit TRICARE.mil/MedicarePartD

For the most up-to-date information on the Medicare Part D prescription drug benefit, beneficiaries should call Medicare.

Specialty medications may also have side effects that require pharmacist and/or nurse monitoring. The specialty medication care management program is structured to improve the beneficiaries through continuous health evaluation, ongoing monitoring and assessment of educational needs and management of medication use. This program provides:

  • Access to proactive, clinically based services for specific diseases
  • Refill reminder calls
  • Scheduled deliveries to beneficiaries’ specified locations
  • Specialty consultation with a nurse or pharmacist at any point during therapy

These services are provided to beneficiaries at no additional cost when they receive their medications through TRICARE Pharmacy Home Delivery, and participation is voluntary. If a patient or provider orders a specialty medication from TRICARE Pharmacy Home Delivery, Express Scripts sends additional information about the specialty medication care management program and how to get started. Beneficiaries enrolled in the specialty medication care management program have access to pharmacists 24 hours a day, seven days a week. The specialty clinical team contacts the beneficiaries’ physicians, as needed, to address beneficiary issues such as side effects or disease exacerbations. If any patients currently fill specialty medication prescriptions at retail pharmacies, the specialty clinical team will provide brochures detailing the program as well as prepopulated enrollment forms.

If a patient requires specialty pharmacy medications, fax the prescription to TRICARE Pharmacy Home Delivery at (877) 895-1900. TRICARE Pharmacy Home Delivery ships medications to the beneficiary’s home. Faxed prescriptions must include the following ID information: patient’s full name, date of birth, address and ID number.