How to fill prescriptions with OHI and TRICARE coverage
If you have TRICARE and Other Health Insurance (OHI), you can receive lower out-of-pocket costs and avoid additional paperwork through online coordination of your prescription benefit.
What is Other Health Insurance (OHI)?
OHI is health insurance you have in addition to TRICARE. If your OHI covers pharmacy benefits, it is your primary coverage for prescriptions. This means it must pay for your medication before TRICARE will pay anything.[1]
How do I know if Express Scripts manages the pharmacy benefit under my OHI?
To find out if Express Scripts manages the pharmacy benefit under your OHI, contact your OHI and ask about your pharmacy and prescription coverage. You can also call Express Scripts at 877.363.1303. Be sure to have the name of your health plan on hand.
How do I fill prescriptions through Home Delivery with Express Scripts Pharmacy®?
If Express Scripts manages the prescription benefit under your OHI, you can use Express Scripts Pharmacy® with your OHI. Your benefits are automatically coordinated using both your OHI and TRICARE. This means you don’t have to file a paper claim to coordinate your OHI and TRICARE pharmacy coverage.
Here’s how to get started with Express Scripts Pharmacy®:
- Ask your provider to e-prescribe your prescription to Express Scripts Pharmacy®
- Download the Express Scripts Mobile App® in the App Store or Google Play
- Visit online to learn more about switching eligible medications to Express Scripts Pharmacy®
Home delivery through Express Scripts Pharmacy® is a convenient service to fill your maintenance medications that you take regularly. As a TRICARE beneficiary you gain access to specialized pharmacists, easy online ordering, and optional autopay services for your prescriptions.
What if I can’t use Express Scripts Pharmacy® with my OHI?
If Express Scripts is not the pharmacy benefits manager for your OHI, you cannot use Express Scripts Pharmacy® and you will need to use a retail network pharmacy or another home delivery program if specified by your OHI pharmacy benefit.
If you use a TRICARE retail network pharmacy, your OHI is the primary payer and TRICARE is the secondary payer.[1] TRICARE becomes the primary payer when your OHI doesn't cover your medication, if you’ve used up your OHI benefit coverage for the year, or if the TRICARE coverage rules apply.
Posted April 29, 2021
[1] Medicare Part D and all other health plans would be the primary coverage over TRICARE, except for Medicaid, TRICARE supplements, State Victims of Crime Compensation Programs, and other Federal Government Programs identified by the Director, Defense Health Agency.
Posted April 29, 2021
