TRICARE beneficiaries with other health insurance no longer have to file paper claims for prescriptions filled at most retail pharmacies. To learn more about this enhancement, please read the press release on the TRICARE website.
In addition, common questions and answers about recent Coordination of Benefits (COB) changes are shown below.
Why am I no longer getting reimbursed the full amount as I was before? I'm submitting everything exactly the same with my manual claim.
Beginning 4 April 2006, you will receive reimbursement up to the TRICARE benefit. TRICARE will determine how much they would have paid if they were the Primary Payer; this amount is calculated by determining the drug cost and then subtracting the applicable TRICARE copayment. You will receive reimbursement up to the TRICARE benefit; not exceeding OHI copayment. This benefit is now in compliance with TRICARE regulations.
Why wasn't I informed about online COB?
While beneficiaries weren’t notified of this new capability, notification was sent to all participating TRICARE retail pharmacies letting them know Coordination of Benefit claims for TRICARE beneficiaries could be submitted electronically as of 4 April 2006.
If I disagree with the current policy, who can I contact?
If you are upset about your current plan guidelines and you would like to express those concerns, please send your concern in writing to:
Express Scripts, Inc.
P.O. Box 60903
Phoenix, AZ 85082-0903
Fax: 877-242-1819
You will receive a response in 30 business days.
Why wasn't I notified in writing the procedures where changing?
Beneficiaries were not notified because there was not a change in the TRICARE benefit. Changes were made so the claim would pay properly, which may have resulted in a different outcome than you previously experienced, but the TRICARE benefit did not change, so beneficiaries were not notified.
Why are your total costs on the TRICARE EOB different from what I show on my print out from the
pharmacy?
Amounts on the pharmacy printout can reflect a Usual and Customary price, and this does not always reflect the actual cost of the medication under the TRICARE benefit.