Many community pharmacies are leaving Tricare network

LAWTON, Okla. (KSWO) - Military families who use community pharmacies will soon need to check if their pharmacy is still in the Tricare insurance network.

According to the Military Officers Association of America, nearly 15,000 community pharmacies are leaving the Tricare network.

This will affect about 4% of the Tricare-eligible population starting on October 24.

A new policy change means many Tricare beneficiaries are getting letters from Express Scripts saying their current pharmacy will no longer be considered in-network.

“Different pharmacy chains and even small mom and pops will either be in-network or out-of-network, and that is something that changes every few years with the contract cycling,” Dr. Matthew Desmarais, OutPatient Pharmacy Supervisor.

If your current pharmacy is out of network, there are many options to switch pharmacies through a prescription transfer process.

“To bring the pharmacy where you want you to have it filled whether it be us or another in-network pharmacy. Bring the bottle where it has all the necessary information. And they will accurately transcribe everything over and then we will take ownership on that prescription order,” Dr. Desmarais said.

You can also call your doctor and ask them to change your pharmacy location. If you forget and aren’t with an in-network pharmacy, there will be an out-of-pocket charge for that prescription.

“The claim would be rejected when they try to bill it to Tricare, but it would involve and increase the cost for most medications.” Dr. Desmarais said.

Reynolds Army Health Clinic is located on Fort Sill’s installation, where all Tricare beneficiaries are able to fill their prescription with no co-pays.

Colonel Daniel Bridon said it’s their mission to take care of and improve the health of the Fires community.

“We do everything we can within the structure of the military health system to deliver that and we are here all the time to make sure that care is delivered,” Bridon said.

There has also been a change in processing for more expensive prescriptions with Tricare, involving prior authorization.

“So what that means is before we can get a label to print we actually have to have a paid claim by Tricare,” Dr. Desmarais said.

He said this is not how they used to operate prior to March of this year, the billing was done after the prescription was given to the patient.

“So, what this means is on some specialty meds and medications, that are typically brand name and high cost, there is what’s called a prior authorization potential,” Dr. Desmarais said.

This will require extra communication with your doctor and Tricare, which could sometimes delay the process.

“If the provider is using the online portal some prior authorization can be adjudicated electronically by the computer, immediately. So it can be almost instantaneously, as soon as the doctor is able to act on that. However, if the provider is choosing to do it through fax or phone it could potentially be a week or two,” Dr. Desmarais said.

To see what pharmacies are in Tricare Network in your area click here.

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