When an outage occurs, your pharmacist can’t verify your benefits. There’s the unlikely event of a Defense Enrollment Eligibility Reporting System (DEERS) outage.Generally, when you have OHI pharmacy benefits, your OHI pays first, and TRICARE pays second. Reimbursement with OHI requires coordination of benefits to decide how much each company will pay on a claim. In this case, Express Scripts will coordinate with the OHI and TRICARE. The other exception is if the OHI also allows Express Scripts home delivery. You must also provide your pharmacist with both your OHI and TRICARE information. You won’t have to pay out of pocket or file a claim if the pharmacy is in network for both your OHI and TRICARE. According to the TRICARE Pharmacy Program Handbook, you may need to file a claim if you have OHI that offers pharmacy coverage. OHI may be through your employer or a private plan you’ve purchased. You have other health insurance (OHI).Remember, reimbursements are subject to deductibles, out-of-network cost-shares, TRICARE formulary status, and applicable copayments. You’ll pay the full amount of the prescription upfront and file a claim for reimbursement. territories (American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. You filled your prescription at a TRICARE non-network pharmacy in the U.S.Under the TRICARE Pharmacy Program, which Express Scripts administers, you’ll need to file a claim for prescription drugs if: If you’re like most beneficiaries who get your prescription drugs filled at a military pharmacy, through TRICARE Pharmacy Home Delivery, or at a TRICARE retail network pharmacy, you don’t need to file a claim. However, some pharmacy options will require you to submit a claim, so it’s important to understand the process.” “In most cases, you won’t have to file pharmacy claims. Teisha Robertson, a pharmacist with the Defense Health Agency’s Pharmacy Operations Division. “The TRICARE Pharmacy Program is a comprehensive pharmacy benefit, which offers a number of efficient and cost-effective ways to fill your prescription drugs,” said U.S. Here’s an overview of when and how to successfully file pharmacy claims. When you use the TRICARE Pharmacy Program benefit, you may wonder if you must file claims for reimbursement for prescription drugs.
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