TRICARE Pharmacy (TPharm)
Chapter 23
Section 1
General
Revision: C-76, October 5, 2020
1.0 General
1.1 The TRICARE
Pharmacy (TPharm) Benefits Program offers worldwide services through:
• Direct Care (DC) pharmacies
located at Military Treatment Facilities (MTFs)/Enhanced Multi-Service Markets
(eMSMs);
• Retail network pharmacies;
• Retail non-network
pharmacies;
• A Mail Order Pharmacy (MOP)
program; and
• Specialty pharmacies.
1.2 The requirements/guidelines
in this chapter apply only to the TPharm contractor.
2.0 Eligibility
2.1 The TPharm
Benefits Program is available to all beneficiaries who
show as TRICARE eligible in Defense Enrollment Eligibility Reporting
System (DEERS), as well as direct care only eligible beneficiaries
who have access to direct care pharmacy services only.
Eligible beneficiaries do not need to enroll separately
from any medical enrollment in order to use the pharmacy
program.
2.2 The
contractor shall refer to Chapter 17, Section 3 for
management of 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
.
2.3 The Government
will assess Guard or Service members who are injured
or become ill while serving on active duty or performing official
drills with their unit
for
eligibility
of 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
shall 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
.
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