TFL Claims. Claims processing and customer service for TFL participants is handled by Wisconsin Physician Service (WPS). Beneficiaries can contact WPS at 1–866–773–0404 or visit the WPS online resource center at www.TRICARE4u.com. In most cases, you will not have to file a claim yourself. Your provider will file the claim with Medicare then Medicare will pay its portion and automatically forward the claim electronically to TRICARE for processing. Long Term Care. Long term care is not a covered benefit under either Medicare or TFL. Consequently, the costs of long term care must be borne by either the beneficiary or through private insurance. As a general rule, long term care involves situations where individuals require assistance with their non-medical personal care needs. Normally people who are unable to perform at least two activities of daily living (i.e., eating, dressing, bathing, etc.) are considered to be in a long term care status. 3–5. TRICARE YOUNG ADULT. The TRICARE Young Adult (TYA) program allows qualified adult children to purchase TRICARE coverage after eligibility for “regular” TRICARE coverage ends at age 21 (or 23 if enrolled in college). Eligible enrollees must be unmarried, adult children under age 26 of active or retired service members. Adult children of non-activated or retired Guard and Reserve members who participate in the TRICARE program are also eligible. The program covers inpatient and outpatient medical care and pharmacy benefits, however, dental care is not covered. Premiums are on a calendar year basis. For 2022 the Prime option costs $512 per month and the Select option costs $265 per month. 3–6. PHARMACY BENEFITS. The TRICARE pharmacy program offers four ways to have prescriptions filled: a. Military Pharmacy. Prescriptions may be filled (up to a 90–day supply for most medications) at a military pharmacy free of charge. Beneficiaries should contact their local military pharmacy for specific details about filling and refilling prescriptions at its pharmacy. b . Home Delivery. A 90–day supply of most prescriptions (either generic or brand name) is available on a prepaid, cost share basis. Enroll online at https://militaryrx.express-scripts.com or call 1–800–363– 1303.
c. Network Pharmacy. You can obtain a 30–day supply of most prescription medications on a cost share basis through a civilian pharmacy in the TRICARE network. Information on participating civilian pharmacies can be obtained at www.tricare.mil/networkpharmacy. This approach allows you to quickly obtain medication that you must start taking immediately. However, for long-term medications, the military pharmacy or home delivery approaches are more cost effective. d. Non–Network Pharmacy. This is the most expensive option. You usually have to pay the full amount first and then file a claim for reimbursement. All deductibles must be met before you will reimbursed. The reimbursement form is called the Patient’s Request for Medical Payment, Form 2642. The form is available at any Military Treatment Facility (MTF) or at www.tricare.mil .
All beneficiaries except active duty service members are required to refill select brand name maintenance
Your Pharmacy Cost
Brand Name Drugs
Non- Formulary Drugs
Place of Service Generic Drugs
Military Pharmacy (up to 90 day supply)
$0
$0
N/A
Home Delivery (up to 90 day supply)
$12
$34
$68
Network Pharmacy (up to 30 day supply)
$14
$38
$68
PRIME : 50% after POS fees. ALL OTHERS : $38 or 20% of total drug cost (whichever is greater).
PRIME : 50% after POS fees. ALL OTHERS $68 or 20% of total drug cost (whichever is greater).
Non-Network Pharmacy (up to 30 day supply)
CHAPTER 3: TRICARE
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