Does TRICARE for Life Cover Prescription Drugs?

TRICARE for Life (TFL) is Medicare-wraparound coverage for TRICARE beneficiaries who are entitled to Medicare Part A and enrolled in Medicare Part B. It provides extensive coverage to supplement Medicare, but one common question is:

Does TRICARE for Life pay for prescription drugs?

The answer is yes. Prescription drug coverage is included with TFL under the TRICARE Pharmacy Program. Let’s take a detailed look at how TFL prescription benefits work.

Prescription Drug Coverage with TRICARE for Life

TFL was designed to compliment Medicare, covering most out-of-pocket costs after you meet your yearly Medicare Part B deductible. This includes helping pay Medicare prescription drug plan deductibles, cost shares, and copays.

Specifically, TFL provides prescription coverage in these ways:

• Pays Medicare Part D plan premiums, deductibles, and cost shares
• Acts as a wrap-around by paying costs after you meet your Medicare Part D catastrophic coverage threshold
• Provides coverage if you opt out of Part D through the TRICARE Pharmacy Program

You have flexibility in how you get TFL drug coverage:

• Option 1: Enroll in a Medicare Part D plan. TFL acts as a secondary payer, covering most out-of-pocket expenses and premiums.

• Option 2: Use the TRICARE Pharmacy Program as your prescription coverage instead of Part D. You pay cost shares under the TRICARE drug formulary.

Either way, TFL includes comprehensive prescription benefits to supplement Medicare’s drug coverage gaps.

TRICARE Formulary Coverage with TFL

If you use the TRICARE Pharmacy Program for drug coverage with TFL, you have access to the TRICARE Formulary. This is a list of covered generic and brand name prescription drugs.

The TRICARE Formulary includes most FDA-approved prescription medications. Drugs fall into categories:

• Generic formulary drugs – Lowest out-of-pocket costs
• Brand-name formulary drugs – Higher cost share
• Non-formulary drugs – Highest cost share, may require prior authorization
• Non-covered drugs – Not covered by TRICARE

You can search for specific drug coverage and costs using the TRICARE Formulary Search Tool. Your medications may require prior authorization or have quantity limits, so always check first.

TRICARE Pharmacy Program Costs with TFL

If using the TRICARE Pharmacy Program, your prescription drug costs with TFL include:

• No deductible to meet
• Fixed copays per prescription based on type – generic, brand, non-formulary, etc.
• No annual out-of-pocket maximum on drug costs

Copays vary based on:

• Where you fill your prescription – military pharmacy, network retail, TRICARE Home Delivery, or non-network pharmacy
• Drug type – generic, brand, non-formulary
• Days’ supply – 30 days or less vs. greater than 30 days

Refer to the TFL Costs page for details on prescription copays. Using home delivery often offers the lowest costs.

Medicare Part D Prescription Coverage

If you enroll in a Medicare Part D prescription drug plan, TFL helps cover your out-of-pocket expenses. Here’s how it works:

• Pay your Part D plan’s monthly premium. TFL reimburses you for this cost.

• Meet your Part D deductible if the plan has one. TFL covers all or most of this amount.

• Pay copays or coinsurance amounts during the initial coverage phase. TFL pays the copays for formulary drugs.

• Enter the coverage gap phase. You pay 25% coinsurance for covered brand and generic drugs. TFL picks up the tab and you pay nothing.

• Reach catastrophic coverage with high total drug costs. You pay a small coinsurance or copay. TFL again picks up the rest.

Filling Prescriptions with TRICARE for Life

To fill prescriptions under the TRICARE Pharmacy Program with TFL:

• Use military pharmacies when available for lowest costs
• Fill prescriptions at TRICARE network retail pharmacies without enrollment fees
• Get home delivery through Express Scripts for 90-day supplies

If using a Medicare Part D plan:

• Use network pharmacies in the plan’s network
• Follow Part D plan rules for filling prescriptions
• File claims with TFL for reimbursement of your out-of-pocket costs

Are Any Drugs Not Covered by TFL?

Most FDA-approved prescription medications are covered. However, TFL does not cover:

• Drugs for weight loss or weight gain
• Fertility drugs
• Cosmetic drugs like Propecia and Renova
• Brand drugs that have generic equivalents (unless medically necessary)

There are also limits on amounts of some drugs like opioids that can be filled. Always check coverage first before assuming a drug is covered.

What If I Have Other Prescription Coverage Too?

If you have additional health insurance with prescription benefits along with TFL, coverage coordination comes into play.

Generally:

• Your other plan is primary payer
• TFL coordinates benefits as secondary payer
• Combined you have little to no out-of-pocket costs

But cost shares under your other insurance plan won’t count toward TFL pharmacy deductibles and out-of-pocket limits since they come first in payment order.

Do Medicare Advantage Plans Include TFL Drug Coverage?

If you’re in a Medicare Advantage plan, coverage depends on the type of plan:

• Medicare Advantage Part C plans include creditable prescription drug coverage, so TFL only assists with premiums.

• Medicare Part D plans require joining a separate Medicare Part D plan with TFL as the secondary payer.

• Medicare Advantage Private Fee-for-Service plans don’t offer prescription coverage, so you use TFL for drug benefits.

If ever in doubt about your coverage, contact the plan directly. TFL benefits like drug coverage will vary based on the specifics of the Medicare Advantage plan.

Does TRICARE for Life Have Dental or Vision Drug Coverage?

TFL does not assist with dental or vision drug costs like:

• Fluoride treatments
• Medicated eye drops
• Contact lens solutions

These may be covered under separate TRICARE dental or vision plans you purchase. But TFL prescription benefits are limited to standard medical drug coverage.

Getting TRICARE for Life Prescription Help

For assistance with TFL pharmacy benefits and claims:

• Visit the TFL prescription page for details

• Contact Express Scripts at 1-877-363-1303

• Speak to a TRICARE representative for claims questions

Understanding exactly what prescription drug costs TFL covers is key to making the most of your benefits. But in short—yes, TRICARE for Life includes robust coverage for prescriptions to supplement Medicare.