Pharmacy Costs
Medicare Part D Coverage
Medicare Part D prescription drug coverage is available to everyone with Medicare Part A and/or Medicare Part B coverage, including Medicare-eligible TRICARE beneficiaries. However, Medicare-eligible TRICARE beneficiaries are not required to enroll in a Medicare Part D prescription plan to retain TRICARE eligibility.
You may direct eligible beneficiaries who inquire about Medicare Part D coverage to visit
TRICARE's Medicare Part D information. However, for the most up-to-date information on the Medicare Part D prescription drug benefit, beneficiaries should call Medicare at
1-800-MEDICARE (
1-800-633-4227) or visit the
Medicare web site.
Pharmacy Data Transaction Service
The Pharmacy Data Transaction Service (PDTS) creates a global centralized data repository that records information about prescriptions filled for DoD beneficiaries at MTF and TRICARE retail network pharmacies, and through the Mail Order Pharmacy. PDTS improves the quality of prescription services and enhances patient safety by reducing the likelihood of adverse drug-drug interactions, therapeutic overlaps, and duplicate treatments across the highly transient population of active duty and retired beneficiaries.
PDTS conducts an online prospective drug utilization review (a clinical screening) against a beneficiary’s complete medication history for each new or refilled prescription in real time before it is dispensed to the patient. Regardless of where a beneficiary fills a prescription within the Military Health System, information about the prescription is stored in a robust central data repository and is available to authorized PDTS providers as a seamless enhancement to the current workflow processes. Authorized PDTS providers include the Mail Order Pharmacy,MTF pharmacies, MTF providers, and all TRICARE retail network pharmacies.
Mail Order Pharmacy Specialty Medication Prescription Service
Specialty prescription medications are high-cost injectable, oral, or inhaled drugs that a patient can self-administer. Effective November 4, 2009, TRICARE beneficiaries will be able to benefit from the Specialty Medication Care Management program services when filling prescriptions for these medications through the Mail Order Pharmacy. Services include clinical assessments, refill reminders, beneficiary education, and side-effect management in order to improve safety and therapeutic outcomes.
Patients enrolled in this program have access to pharmacists 24 hours a day, seven days a week. The specialty clinical team will also reach out to the beneficiaries’ physicians, as needed, to address beneficiary issues, such as side effects or disease exacerbations. If any of your patients are currently having specialty medication prescriptions filled at a retail pharmacy, our specialty team will provide brochures detailing our specialty services as well as a prepopulated enrollment form.
If one of your patients requires specialty pharmacy medications, you may fax the prescriptions to the Mail Order Pharmacy from your office. The Mail Order Pharmacy will ship specialty medications to the beneficiary’s home. Faxed prescriptions must contain the following identification information in order to be processed:
- patient’s full name
- date of birth
- address
- ID number
Effective November 4, 2009, prescriptions should be faxed to
1-877-895-1900.
Note: Some specialty medications may not be available through the Mail Order Pharmacy because the medication’s manufacturer limits the drug’s distribution to specific pharmacies. If you submit a prescription for one of these limited distribution medications, the Mail Order Pharmacy will either forward the prescription to a pharmacy that can fill it or will provide you with instructions about where to send the prescription to have it filled.
For a list of specialty medications covered under the pharmacy benefit, refer to the
TRICARE Operations Manual, Chapter 23, Addendum A.
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