About 35,000 Tricare Users Overcharged for Prescriptions

A misunderstanding by Tricare's pharmacy contractor caused about 35,000 beneficiaries to be overcharged for medications early this month, officials told Military.com on Friday.

"Express Scripts misinterpreted a plan design rule in Defense Health Agency manuals, which resulted in some beneficiaries paying a deductible on prescriptions filled at an in-network pharmacy when they should not have been," Jennifer Luddy, a spokesperson for Express Scripts, said in a statement. "About 35,000 beneficiaries were impacted."

The error occurred on Jan. 1 and Jan. 2, officials said. It was "identified and resolved" on Jan. 2, Luddy said. 

Any Tricare beneficiary who used an in-network retail pharmacy on those dates, including Tricare for Life users and military retirees, may have been affected by the error.

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Tricare users early this month reported on social media suddenly being charged hundreds of dollars at in-network retail pharmacies for prescriptions that had previously carried only a small co-payment.

A series of major network changes was implemented by Tricare on Jan. 1, included a shift in regions, new network contractors and a new price structure for care -- but no changes were made on that date to prescription drug prices or coverages.

Tricare officials did not respond at the time to Military.com requests for information on the problem.

Prescription drugs purchased by Tricare users at retail pharmacies always carry co-pays, depending on type of medication and supply purchased. Currently, those prices are $10 for a 30-day supply of a generic drug, $24 for a 30-day supply of a brand-name drug, and $50 for non-formulary drugs.

On Feb. 1, those prices will increase to $11 for generics, $28 for brand-name drugs, and $53 for non-formulary drugs.

Beneficiaries who were overcharged on the specified dates do not need to take any action and will be reimbursed by Express Scripts for the overcharge, Luddy said in her statement.

"We have been working with beneficiaries and pharmacies to either re-submit the claims, or to provide a refund of the deductible amount that was paid by the beneficiary," she said. "There is no action required of beneficiaries at this time; if they paid a deductible on an in-network claim when they should not have, they will receive a refund from us."

-- Amy Bushatz can be reached at amy.bushatz@military.com.