TRICARE, Your Military Health Plan

Other Health Insurance

When you have other health insurance (OHI) with a prescription drug plan, your OHI is the first payer for prescription coverage, and the rules of that insurer will apply.  After your OHI has paid, you may be able to receive a partial or full reimbursement from TRICARE when you file a prescription claim.

To avoid higher out-of-pocket costs, use a retail pharmacy that is both covered by your OHI plan and is in the TRICARE retail network.

OHI and the TRICARE Pharmacy Home Delivery
You are not eligible to fill prescriptions via home delivery if you have OHI with a prescription plan, including a Medicare Part D prescription program, unless you meet one of the following requirements:

• Your OHI does not include pharmacy benefits.
• The medication you need is not covered by your OHI.
• You have met your OHI's benefit cap (i.e., you have met your benefit's maximum coverage limit).

Once you have met one of these requirements, you may submit your prescription to the TRICARE Pharmacy Home Delivery. Ask your provider to write a prescription for up to a 90-day supply and follow these instructions:

• Complete the New Patient Home Delivery Form, available at www.express-scripts.com/TRICARE. Mail the form, your written prescription, and payment to:
  

Express Scripts
P.O. Box 52150
Phoenix, AZ 85072-9954

• Payment may be made by credit card, check, or money order. To ensure proper prescription fulfillment, follow all instructions on the form. Make sure to include the following information on the back of each prescription: patient's full name, date of birth, address, and sponsor's identification number.

If your medication is not covered by your OHI (i.e., declined for payment by your OHI), or if you have met your benefit maximum, you will need to include proof from your OHI, such as a copy of an explanation of benefits (EOB). This information must accompany your prescription in order for it to be filled via home delivery.

If your OHI provides only medical coverage (not pharmacy coverage), you still may be eligible to use the TRICARE Pharmacy Home Delivery as your prescription benefit. Call Express Scripts at 1-877-363-1303 for more information.

OHI and the TRICARE Retail Pharmacy Network
Having OHI does not prevent you from using a TRICARE retail network pharmacy. If you have pharmacy benefits through your OHI, TRICARE becomes the second payer by law. Note: Supplemental and discount prescription drug programs, such as Senior Friends and American Association of Retired Persons (AARP), do not count as OHI pharmacy coverage.

Online Coordination of Benefits
If you have OHI, you can take advantage of online coordination of benefits (COB). Tell your pharmacist you have TRICARE coverage in addition to your OHI when you have your prescription filled at your participating pharmacy. Your pharmacist will submit your prescription online to both plans at the same time.

Advantages of having your COB claims processed online include:

• Minimal out-of-pocket expenses
• Never paying more than the TRICARE copayment
• No need to submit paper claims
• Reduced or eliminated up-­front costs

TRICARE becomes the first payer when:

• The drug is not covered by your OHI, but is covered by TRICARE.
• Coverage under your OHI is exhausted for the benefit year.

If you are using a mail­order program available through your OHI, online COB is not an option.

To be reimbursed for the eligible portion of your out-of-pocket expenses, you must file a prescription claim. Billing statements showing only total charges, canceled checks, or cash register and similar type receipts are not acceptable as itemized statements, unless the receipt provides the required detailed information noted above. When filing a claim, include a copy of your OHI provider's EOB if one is available to you, in addition to your prescription receipts. Your claim may be returned for clarification if there is missing or incomplete information. 

Keep your receipts!

Enrolled in the US Family Health Plan?

Last Modified: July 21, 2010