OHI and Pharmacy Benefits
When you have other health insuranceHealth insurance you have in addition to TRICARE, such as Medicare or an employer-sponsored health insurance. TRICARE supplements don’t qualify as "other health insurance." with pharmacy benefits, your other health insurance is the first payer and TRICARE pays second. You can avoid higher costs by getting your prescriptions filled at a TRICARE network pharmacy that is also in your other plan's network.
TRICARE Pharmacy Home Delivery
You can’t use Home Delivery when you have other health insurance, unless:
- Your other plan doesn’t include pharmacy benefits,
- The drug you need isn’t covered by your other plan, or
- You’ve met the other plan’s benefit cap
If you’ve met any of these requirements, you can get your prescription filled through Home Delivery. You'll need to send proof from your other plan that it isn't covered or you've met the benefit cap.
TRICARE Network Pharmacies
If you have other health insurance, it doesn’t prevent you from using a TRICARE retail network pharmacy. Your other plan pays first and TRICARE pays second.
Online Coordination of Benefits
When you get your prescriptions at a network pharmacy, tell your pharmacist you also have TRICARE. Your pharmacist will submit your prescription online to both plans at the same time.
When you process your pharmacy claims online, you:
- Pay minimal out-of-pocket expenses
- Never pay more than the TRICARE copaymentA fixed dollar amount you may pay for a covered health care service or drug.
- Don't need to submit paper claims
TRICARE becomes the first payer when:
- The drug isn't covered by your other plan, but is covered by TRICARE
- Coverage under your other plan is exhausted for the year
If you're using a mail order program through your other plan, online coordination of benefits isn't possible.
You must file a prescription claim to get reimbursed for the eligible portion of your out-of-pocket expenses.
Ending Other Health Insurance Coverage
If you are no longer covered by other health insurance with pharmacy benefits, you must update your status with the TRICARE pharmacy contractor. >>Contact Express Scripts
Last Updated 6/14/2023