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.