If you have a question you would like answered, send it to Veteran Advisor, Veterans Benefits Department, 801 Eighteenth Street, NW, Washington, DC 20006. All inquiries will be answered, but only those of general interest to our readers will be published.
Question: I heard that the Department of Defense (DOD) recently made its pharmacy benefits available to all Medicare-eligible military retirees, dependents, and survivors. Is this true? How does it work?
Answer: You are correct. The FY 2001 National Defense Authorization Act included legislation extending the DOD Pharmacy Benefit to all Medicare-eligible retirees, dependents, and survivors 65 years of age or older. Enrollment fees or premiums are not required.
The new program will reduce out-of-pocket costs and increase access to DOD's National Mail Order Program (NMOP) and retail pharmacies that are part of the DOD network, which includes many major chain drug stores. In addition, beneficiaries may use non-network retail pharmacies.
As of April 1, 2001, the triple-option plan will allow Medicare-eligible beneficiaries a choice of filling prescriptions via one of the following:
* Military pharmacy at a local military treatment facility
* Civilian retail facility
* DOD's National Mail Order Pharmacy
The first option may be the best, because the service is convenient and free (no co-payment). Beneficiaries may use any military treatment facility pharmacy run by the U.S. Army, Navy, Air Force, or Coast Guard.
The second option--civilian retail facilities--is open to TRICARE Prime beneficiaries who may use a civilian pharmacy in TRICARE's pharmacy network. This option requires a $9 co-payment for a 30-day supply of medication. Beneficiaries can contact their regional TRICARE contractor for a list of network pharmacies in their region. Individuals who use pharmacies outside the network are responsible for the first $300 of prescription costs and 50% of prescription costs above the deductible.
By law, TRICARE's retail and mail-order benefit is limited to beneficiaries age 65 and over who are eligible for Medicare Part A and enrolled in Part B. There is an exception: Individuals who turn 65 before April 1, 2001, are eligible for the benefit, even if they are not enrolled in Medicare Part B.
If you are not enrolled in TRICARE Prime but still use a TRICARE network pharmacy, you will be responsible for 20% of the discounted cost of the drug through TRICARE Extra.
If you are not enrolled in TRICARE Prime and use a civilian pharmacy that is not part of the TRICARE network, you must pay 25% of the prescription's retail cost, as well as a $150 outpatient annual deductible.
The third option, NMOP, offers free delivery to beneficiaries' residences, limits the co-payment to $8 for retirees and family members, and does not require an annual deductible.
NMOP is administered by Merck-Medco RX Services and is a generic-based pharmacy service primarily for uniformed service beneficiaries requiring maintenance medications to treat chronic disorders.
Retired beneficiaries living overseas can use their TRICARE benefit at overseas pharmacies but need to submit their pharmacy claims for reimbursement. They also will be able to use NMOP if certain requirements are met. Federal and state legal restrictions apply to the prescribing, dispensing, and mailing of prescription drugs, so NMOP can only mail to Army Post Offices (APOs) or Fleet Post Offices (FPOs) that are part of the U.S. Postal Service. Also, NMOP can only fill prescriptions written by providers licensed to practice in the United States.
Effective October 1, 2001, Medicare -eligible military beneficiaries become eligible for all TRICARE benefits. Benefit Alert, a monthly PN feature, provided a summary of this development in the March 2001 issue. The law requires that all Medicare-eligible beneficiaries, regardless of age, must be enrolled in Medicare Part B to receive the other TRICARE benefits; they should enroll in Part B as soon as they are eligible. The annual "open season" for enrollment in Medicare Part B is January 1 through March 31. Information about Medicare enrollment is available at local Social Security Administration offices or on the Medicare Web site at www.medicare.gov/ Basics/Overview.asp.
One of the most important steps eligible beneficiaries can take to ensure access to the expanded pharmacy and other TRICARE benefits is to update their Defense Enrollment Eligibility Reporting System (DEERS) record with their correct address and any changes in family status, such as marriage, divorce, birth, or adoption. Updating DEERS records has several avenues:
* MHS/TRICARE Web site, www.tricare.osd.mil/ DEERSAddress
* Nearest military personnel office that has an ID-card facility
* Local military treatment facility
* The Defense Manpower Data Center Support Office (DSO) telephone center, (800) 538-9552. (The best time to call is between 9:00 a.m. and 3:00 p.m. [Pacific Time], Wednesday through Friday.)
* Mail address change to DSO, Attn: COA, 400 Gigling Road, Seaside, CA 93955-6771.
* Fax address change to DSO, Attn: COA at (831) 655-8317.
* Send an e-mail message to addrinfo @osd.Pentagon.Mil. Messages should be lower case only and include sponsor's name, Social Security and telephone numbers, name(s) of beneficiaries affected by address change, and effective date for the change.
To update DEERS information other than address changes, contact the nearest military ID-card-issuing facility to determine the required documentation for needed changes. You may also mail or fax appropriate documentation to the DSO and include an attention line, Attn: R&A. Requests received without the required documentation will be returned unprocessed.
For additional information on the pharmacy benefit and other benefit issues, visit the following resources:
National Defense Authorization Act tricare.osd.mil/ndaa
If you elect to use Merck-Medco, the following contact information will be useful:
Merck-Medco Web site, www.merck-medco.com
Order refills online/additional information about services.
Member Services, (800) 903-4680
Order refills or request mail service envelopes (#M847), an NMOP brochure (#99N), a patient profile registration. Beneficiaries who live overseas should call (614) 421-8211 if the toll-free number is not available.
Merck-Medco RX Services, (888) 327-9791, or Easy-RX- 1
Provides instructions to physicians for faxing prescriptions directly to NMOP. Mail orders should be addressed to Merck-Medco RX Services, P.O. Box 1014, Summit, NJ 07902-9895.
Merck-Medco RX Services Credit Card Autocharge Enrollment, (800) 948-8779
Automated system allows beneficiaries to charge future orders to credit cards.
A description of drugs included in NMOP's formulary.
RICHARD GLOTFELTY Associate Executive Director, Veterans Benefits