Military Health System

1.1  The TRICARE Pharmacy (TPharm) Benefits Program offers worldwide services through:

1.2  The requirements/guidelines in this chapter apply only to the TPharm contractor.

2.1  The TPharm Benefits Program is available to all TRICARE eligible beneficiaries, including Uniformed Service members, TRICARE Prime Remote (TPR) enrollees, TRICARE Dual Eligibles, and TRICARE Reserve Select (TRS) members. Eligible beneficiaries need not enroll in order to use the pharmacy program. The contractor shall use the Defense Enrollment Eligibility Reporting System (DEERS) to verify TRICARE eligibility prior to dispensing pharmaceuticals (or paying any claim) for all beneficiaries, except for certain beneficiaries during calendar year 2018. See Chapter 8, Section 1.

2.2  Foreign Force Members (FFMs) and their dependents from countries that are party to a North Atlantic Treaty Organization (NATO), Status of Forces Agreement (SOFA), or Partnership for Peace (PfP) SOFA (see Chapter 17, Section 3) may be eligible to receive pharmaceuticals dispensed through retail pharmacies. If eligible, coverage will be subject to the same rules regarding adjudication and payment as applicable to U.S. active duty members (no copay or cost-share) and Active Duty Family Members (ADFMs) with TRICARE Standard (through December 31,2017) and with TRICARE Select Group B cost-shares (effective January 1, 2018). See the TRICARE Reimbursement Manual (TRM), Chapter 4, Sections 2 and 4, for coordination of benefits rules. Refer to http://tricare.mil/CoveredServices/Pharmacy/Eligibility.aspx for information on potential coverage.

2.3  Guard or Service members who are injured or become ill while serving on active duty or performing official drills with their unit may be eligible for continued care/treatment associated with the specific episode of care once their active duty or drill status has terminated. Documentation from Specified Authorization Staff (SAS) will serve as proof of eligibility and pharmaceutical claims will be processed for reimbursement. SAS, per Chapter 17, Section 2, paragraph 1.2, has authority to approve claims for drugs not covered under standard benefit guidelines.