Looking for Medicare Makeover stories
The Centers for Medicare & Medicaid Services (CMS) is asking us to identify “Medicare Makeover” stories during this year's Medicare Open Enrollment Period (OEP). They're specifically searching for beneficiaries who look at the different plan options available to them and find one that perhaps offers lower co-pays for their medicines or a wider network of providers in their area. With the approval of the beneficiary, CMS plans to connect them with local health reporters to bring to life the value of researching plans during Medicare OEP. CMS is looking for at least one makeover story in each region. Via email, please share, with the beneficiary's permission, their full name, phone number and county with Donna Wells, SHIBA Communications Consultant at: donnaw@oic.wa.gov.
TRICARE benefit changes
As of Oct. 1, 2015, a new law requires all TRICARE beneficiaries, except active duty service members, to get select brand name maintenance drugs through either TRICARE Pharmacy Home Delivery or from a military pharmacy. Beneficiaries who keep using a retail pharmacy for these drugs will have to pay the full cost.
Maintenance drugs are drugs clients take regularly for a long time, such as to control blood pressure or cholesterol. The law does not apply to drugs they take for a short time, like antibiotics, or generic drugs. If they live overseas, or have other prescription drug coverage, they are not affected.
The TRICARE pharmacy contractor, Express Scripts, sent a letter to affected beneficiaries in September explaining their options. Beneficiaries can contact Express Scripts at 1-877-363-1303 if they have any questions.
Now, beneficiaries who fill an affected drug at a retail pharmacy will get another letter from Express Scripts. After that, beneficiaries have one final “courtesy” fill at a retail pharmacy. If they fill at a retail pharmacy again, they have to pay 100 percent of the cost of their medication.
TRICARE Pharmacy Home Delivery is a safe, convenient and low cost option to get maintenance drugs. Beneficiaries save up to $176 a year for each brand name drug they switch from retail to Home Delivery. If clients want to use a military pharmacy, make sure they check first to see if it carries their prescription. For more about this change to TRICARE’s pharmacy benefit, go to: www.tricare.mil/RxNewRules.
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