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Pharmacies & Medications
- Flu Vaccine Update
- Filling Your Prescription
- Retail Pharmacy Network
- Home Delivery
- Covered Medications
- Non-Covered Medications
- Generic Drugs Policy
- Quantity Limits
- Prior-Authorization and Medical Necessity
- Medical Necessity for Non-Formulary Medications (at Formulary Copayments)
- Step Therapy
- Out of Network Claims
- Online Coordination of Benefits
- Specialty Medications
- Drug Information
USFHP members* can receive a free flu vaccine at Rite Aid pharmacies this fall. This convenient option lets you get a vaccine even if you can’t make it to your physician’s office. And best of all, there is no cost to you at all Rite Aid pharmacy locations that provide vaccines!
The Centers for Disease Control (CDC) recommends that everyone 6 months of age and older receive the flu vaccine. Vaccination is especially important for health care workers, young children, pregnant women, people with chronic health conditions and people age 65 years and older.
Influenza is a contagious disease spread by coughing, sneezing, and nasal secretions. Vaccination is the best protection against getting the flu! Getting a flu vaccine at your Rite Aid pharmacy this fall can protect you from flu symptoms this winter, at no cost to you.
To locate a Rite Aid pharmacy near you, visit https://www.riteaid.com/store-locator.
*Applies to members 9 years of age and older.
You may obtain your prescriptions at any of the 5,100 Rite Aid pharmacies nationwide or through home delivery. For the location of a Rite Aid pharmacy near you, call 1-800-748-3243 or visit www.riteaid.com.
Note: You may not obtain prescriptions from a military treatment facility while enrolled in the USFHP. Prescriptions that originated at a military treatment facility may not be transferable to Rite Aid pharmacies.
Any prescriptions filled outside the Rite Aid network in a non-emergent situation will be reviewed for medical necessity and if approved, will be reimbursed at the USFHP contracted rate less applicable co-payment.
This option allows you to fill your prescriptions at any of the approximately 5,100 Rite Aid network pharmacies without having to submit a claim. You may fill prescriptions for up to a 30-day supply of medication at any Rite Aid pharmacy. The Plan also allows beneficiaries to obtain a 90-day supply of most medications for chronic conditions for the same copay as home delivery. To fill a prescription, present your Johns Hopkins USFHP Member ID Card to the pharmacist with your prescription. You will be required to pay a co-payment (co-pay) at the time of service. The co-pay levels are printed on your ID card. Your ID card also contains important information to allow the pharmacy to process your claim correctly.
To locate a Rite Aid pharmacy near you, visit https://www.riteaid.com/store-locator.
Home delivery is available for up to a 90-day supply of approved medications through Rite Aid at Wyman Park. With home delivery you enjoy the convenience of free delivery to your home or any designated address. Home delivery is best suited for medications you take on a regular basis. To obtain your prescription through home delivery, complete the and send it in with your new prescription or, for a refill, with your prescription number, plus a check or credit card number for your co-payment . Your prescription order is processed promptly and most orders are received within two weeks To ensure you receive a refill before your current supply runs out, re-order at least two weeks before you need your refill.
Rite Aid Pharmacy
2700 Remington Ave.
Baltimore, MD 21211
USFHP members are responsible for a portion of the cost of their medications. The TRICARE formulary contains three cost levels for USFHP members.
Date of last co-pay update: March 1, 2016
The co-pay for prescription drugs at Rite Aid retail up to 30-day supply is as follows:
$10 for Generic drugs, $24 for Brand Name drugs and $50 for Non-Formulary drugs for a 30-day supply.
For Home Delivery up to 90-day supply (maintenance medications only), the Co-pays are as follows:
$0 for Generic drugs, $20 for Brand Name drugs and $49 for Non-Formulary drugs.
You can view the cost share for a medication using the TRICARE formulary search tool. You can also search for lower cost alternative medications to a medication you are currently taking.
This option allows you to fill your prescriptions at any of the approximately 5,100 Rite Aid network pharmacies without having to submit a claim. You may fill prescriptions for up to a 90 day supply at any network pharmacy. The USFHP Pharmacy Program provides outpatient coverage to beneficiaries for medications that are approved for marketing by the U.S. Food and Drug Administration (FDA) and that generally require prescriptions. Other covered medications include:
- Compounded medications of which at least one ingredient is a legend drug
- Insulin syringes and needles
- Smoking Cessation products at no out of pocket cost (Maximum of 2 quit attempts per year)
- Glucose test strips
Prescription medications used to treat conditions that are not currently covered by USFHP either by statute or regulation are likewise excluded from the pharmacy benefit.
Excluded medications include:
- Drugs prescribed for cosmetic purposes
- Fluoride preparations
- Food supplements
- Homeopathic and herbal preparations
- Over-the-counter products (except insulin, diabetic supplies, and smoking cessation products)
- Weight reduction products
USFHP utilizes the TRICARE pharmacy formulary. The TRICARE formulary and pharmaceutical management policies are developed by the Department of Defense Pharmacy and Therapeutics Committee. The TRICARE formulary is a tiered, open formulary and includes generic drugs (Tier 1), preferred brand drugs (Tier 2), and non-preferred brand drugs (Tier 3). View information about the DoD Pharmacy and Therapeutics review and list of formulary drugs.
DoD’s policy on generic drugs require the pharmacy to substitute generic medications for brand-name medications when a generic equivalent is available. Brand-name drugs with a generic equivalent may be dispensed only if your physician submits a medical necessity request and approval is granted by USFHP. In those cases you will pay the brand-name co-payment. If you insist on having a prescription filled with a brand-name drug when a generic equivalent is available, and medical necessity for the brand name drug has not been established, you will be responsible for the entire cost of the prescription.
Generic drugs are chemically identical to their branded counterparts. They are made with the same active ingredients, and produce the same effects as their brand name equivalents. The Food and Drug Administration (FDA) requires generic drugs to have the same quality, strength, purity, and stability as brand name drugs. Also, the FDA requires that all drugs, including generic drugs be safe and effective.
Although generic drugs are chemically identical to their branded counterparts, and are held to the same FDA standards for safety and performance as brand name drugs, they sell for 30-75 percent less. You can save money on your co-payment by choosing generic drugs when applicable. Additional information on generic drugs is available on the FDA website.
The Department of Defense Pharmacy and Therapeutics Committee has established quantity limits for certain medications.
If your medical condition warrants use of quantities greater than listed quantity limit for your medication, your provider may submit a Prior Authorization request for use of the higher quantity. Your physician must provide medical justification for use of the higher quantity. To view TRICARE Quantity Limits on any covered drug, use the formulary search tool and search each drug independently.
Some medications require prior authorization before they can be dispensed.
For a list of prior authorization drugs please visit the TRICARE Pharmacy Prior Authorization Page.
To initiate a prior authorization, your provider must complete and fax the Prior Authorization form to the Johns Hopkins HealthCare Pharmacy department at 410-424-4607.
Prior Authorization requests are reviewed within 48 hours of receipt by Johns Hopkins USFHP. Requests marked as “Urgent” are reviewed within 24 hours.
To ensure safety and effectiveness of compound drug claims and to manage cost, some compound medications when rejected at the pharmacy, may require prior authorization. Ask your provider to complete the Compound Prior Authorization form and fax to the number on the form for review. The provider must provide clinical documentation to support the request and demonstrate that an FDA approved commercially-available product is not clinically appropriate for the member.
Medical necessity criteria are established by the DoD Pharmacy & Therapeutics (P&T) Committee for each non-formulary medication. If the medical-necessity criteria are met, the beneficiary may receive the non-formulary medication at a lower co-payment. Your provider can establish medical necessity by completing and submitting the Pharmacy Prior-Authorization form.
Step therapy involves prescribing a safe, clinically effective, and cost-effective medication as the first step in treating a medical condition. The preferred medication is often a generic medication that offers the best overall value in terms of safety, effectiveness and cost. Non-preferred drugs are only prescribed if the preferred medication is ineffective or poorly tolerated.
Drugs subject to step therapy will be approved for first-time users only after they have tried one of the preferred agents on the DoD Uniform Formulary (e.g., currently a beneficiary must try omeprazole or Nexium® before using any other proton pump inhibitor).
Note: If you filled a prescription for a step-therapy drug within 180 days prior to the implementation of step therapy, you will not be affected by step-therapy requirements and will not be required to switch medications.
In the event that you fill a prescription at a non-network pharmacy due to an emergent situation, you may seek reimbursement for incurred cost. To obtain reimbursement, complete the Prescription Drug Claim form, and mail to the address indicated on the form. You will be reimbursed for the cost of the prescription less applicable co-payment. Any prescriptions filled outside the Rite Aid network in a non-emergent situation will be reviewed for medical necessity and if approved, will be reimbursed at the USFHP contracted rate less applicable co-payment.
US Family Health Plan beneficiaries who have other health insurance (OHI) can take advantage of online coordination of benefits (COB). Tell your pharmacist you have US Family Health Plan coverage in addition to your OHI when you have your prescription filled at your retail network pharmacy. Your pharmacist will submit your prescription online to both plans at the same time.
Advantages of having your COB claims processed online include:
- Zero out-of-pocket expense
- No need to submit paper claims
- Reduced or eliminated up-front costs
US Family Health Plan becomes the first payer when:
- The drug is not covered by your OHI, but is covered by TRICARE
- Coverage under your OHI is exhausted for the benefit year
If you are using a mail-order program available through your OHI, online COB is not an option.
Specialty medications are usually high-cost; self-administered; injectable, oral, or infused drugs that treat serious chronic conditions. These drugs typically require special storage and handling, and may not be readily available at your local pharmacy. Specialty medications may also have side effects that require pharmacist and/or nurse monitoring. Many specialty medications (oral and injectables) are available through the retail pharmacy network. However, some medications may not be available at retail because the medication’s manufacturer limits the medication to specific pharmacies. If your physician submits a request for use of a restricted distribution drug, upon approval USFHP will forward the request to a contracted specialty pharmacy. The specialty pharmacy will coordinate delivery of the medication to patient’s home or physician office.
View information on a drug, including how to take the medication, possible side effects, and drug interactions.