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OHI and TRRx (Article 2)
Using Other Health Insurance with the TRICARE Retail Pharmacy Network

If you have prescription drug coverage through other health insurance (OHI), there are a few important guidelines to follow when using the TRICARE Retail Pharmacy (TRRx) program.

OHI Defined

Any OHI you have in addition to TRICARE is considered your primary insurance and therefore pays first. OHI is any non-TRICARE health insurance you receive through an employer or other public or private insurance program, including government programs such as Medicare Part D.

If your OHI does not provide a copaystructured pharmacy or prescription drug benefit, then TRICARE is the primary payer.

Supplemental or discount prescription drug programs, like AARP, Senior Friends or others, are not considered OHI under the TRICARE benefit. If you participate in one of these programs, then TRICARE is the primary payer.

Certain government programs, like Medicaid, TRICARE supplements and the Indian Health Service, also are secondary payers to TRICARE.

Prescription Claims and OHI

Federal law requires that you use your OHI policy first when filling prescriptions at a retail pharmacy. You may then seek full or partial reimbursement from TRICARE for out-of-pocket costs by completing and mailing a DD Form 2642, along with medication receipts showing the amount that your OHI contributed toward the cost of the medication.
Mail to:
 

Express Scripts
P.O. Box 66518
St. Louis, MO 63166-6518

 

Be sure to complete the OHI section of the claim form. It is important to provide complete, accurate OHI information when submitting paper claims. Claims processing may be delayed if OHI information is incomplete or omitted.

DD Form 2642 is available online or at any military treatment facility or TRICARE Service Center.

When OHI Becomes Second Payer
In certain situations, TRICARE becomes first payer over your OHI, including when:
 
  • The drug is not covered by your OHI, but is covered by TRICARE. To be reimbursed, you must obtain an explanation of benefits (EOB) statement from your OHI company stating the medication is not covered and submit the EOB to Express Scripts with a claim form.
     
  • Coverage under your OHI is used up for the year. You must obtain an EOB from your OHI company stating your OHI coverage ended for the year and submit the EOB to Express Scripts with a claim form.
     
  • Your OHI does not have a pharmacy benefit or is a drug discount plan.
For more information on OHI, visit the TRICARE Web site. For more about your prescription drug benefit, visit Express Scripts Web site  or call 1-866-DoD-TRRx (1-866-363-8779).


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Last Reviewed:  December 4, 2007