Electronic coordination of claims enhances Tricare pharmacy benefit

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Tricare beneficiaries with other health insurance no longer have to file paper claims for prescriptions filled at most retail pharmacies. Retail pharmacists can immediately submit electronic claims to TRICARE when a beneficiary purchases medications.

"It is a great example of how collaboration with our pharmacy contractor significantly enhances our pharmacy program," said Army Major General Elder Granger, deputy director of the Tricare Management Activity. "This new process will significantly reduce the hassle factor for our beneficiaries."

Beneficiaries may still submit paper claims from pharmacies that do not yet participate in this new system.

Previously, Tricare paid claims for beneficiaries with other health insurance through a manual process. Tricare required the beneficiary to mail a claim form and their receipt to Express Scripts Inc., the pharmacy contractor. The new process allows a pharmacy to receive Tricare's payment before requesting a copayment from the beneficiary. In many instances, the beneficiary can leave the pharmacy with lesser out-of-pocket expenses and no requirement to file a claim.

Beneficiaries and pharmacies are pleased with the program. "The ability to coordinate Tricare claims has been very positive for our pharmacy," said Joe Amaro, a pharmacist at Allen Drugs in Jones County, N.C. "Our customers are grateful when we inform them that they don't have to fill out any paperwork," he added.