New senior drug plan provides 'double coverage'
By Tom Philpott
Medicare-eligible military beneficiaries who have prescription drug coverage through their Medigap insurance or employer-sponsored health plans have been upset to learn in recent weeks that they cannot be full participants in the TRICARE Senior Pharmacy program, known as TSRx, which began yesterday.
But that doesn't mean out-of-pocket pharmacy costs won't fall, TRICARE officials say.
New pamphlets on the TRICARE Senior Pharmacy program for beneficiaries 65 and older explain that they cannot use the mail-order portion of TSRx if they have drug coverage under another health plan Ü unless the medication is not covered by the other insurance. If using the TRICARE retail pharmacy network, beneficiaries' other health insurance must be used first to cover any costs, the pamphlet explains.
However, TRICARE will reimburse beneficiaries for any co-payments or other out-of-pocket drug costs they incur, so overall pharmacy benefits should improve, even for those who can't fully participate in TSRx.
"That question comes up repeatedly, and a lot of beneficiaries get really upset," said Army Col. Bill Davies, director of Department of Defense pharmacy programs. "They feel like we've taken something away from them. We had to take a step back too and say, 'Wait a minute! You've really got the best of both worlds.'"
Other insurance "doesn't eliminate your participation in the TRICARE Senior Pharmacy program Ü what you really have is double coverage, with the other insurer being first payer," Davies said.
"The important thing for beneficiaries is to hang on to their receipts [showing] out-of-pocket expenses, and their Explanation of Benefits from their other insurer, because they're going to be able to obtain a partial or full reimbursement of their out-of-pocket expenses," Davies said.
Angered beneficiaries should understand they "really have an even more robust benefit," said Davies.
Drug co-pays revised
April 1 also delivers streamlined pharmacy co-payments for users of the military mail-order and retail-drug network. Beneficiaries will pay $3 for generic drugs and $9 for brand-name medicines. Those rates usually will buy a 30-day supply through the retail network or a 90-day supply through the mail.
TRICARE Prime co-payments for enrolled active-duty family members also will end. Family members seeking care from the network of civilian providers no longer will pay $12 or $6 per visit, depending on the sponsor's rank.
Also ending for active-duty family members enrolled in TRICARE Prime are inpatient charges of $11 per day for a civilian hospital, $11.45 a day in a military facility.
Military Update focuses on issues affecting pay, benefits and lifestyles of active-duty and retired service members. Tom Philpott is a Virginia-based syndicated columnist and free-lance writer.
