TRICARE for Life is the Medicare “wrap-around.” As discussed earlier, TRICARE beneficiaries aged 65 and older who participate in Parts A and B of Medicare are eligible for this plan. They must pay the Medicare enrollment fees but no additional annual TRICARE enrollment fees. Medicare is the first payer; the TRICARE for Life plan generally pays all out-of-pocket Medicare costs and also provides some additional medical benefits (TMA, 2012a).
TRICARE Prime now has a Point of Service option, which allows TRICARE Prime beneficiaries to participate as well in features of TRICARE Standard and TRICARE Extra. Essentially, this option gives beneficiaries a greater choice of providers, although the providers must still be TRICARE authorized. Out-of-pocket expenses also increase. TRICARE Prime provides the most comprehensive benefit, although the choice of providers is more limited than is the case under TRICARE Extra and TRICARE Standard (TMA, 2011b).
TRICARE also has a pharmacy benefit with four options, each of which is available to all TRICARE beneficiaries. Prescriptions can be filled at a pharmacy at a military treatment facility at no cost. Prescriptions can also be filled through a mail order pharmacy program that is managed by a single contracted worldwide pharmacy home delivery vendor. This service is used most often for routine prescriptions taken for chronic conditions. The third option is a retail pharmacy, which includes almost 64,000 contracted network retail pharmacies. The retail pharmacies can dispense a maximum 30-day medication supply. Finally, non-network pharmacies can be used if the other options are not available. The mail order and retail pharmacy programs have some co-payments, which vary with beneficiaries’ duty status and whether the prescription is for generic or brand name products. Waivers are possible for nonformulary pharmaceuticals (TMA, 2012b).
The preceding sections describe how ADSMs, members of the National Guard and Reserves, and their dependents access health care through the direct and purchased care systems. This section explains how each of these groups accesses SUD care in particular.
SUD Care Provided Through the Direct Care System
The SUD care available in the direct care system for service members and their dependents varies by service branch and location. The way each branch approaches prevention, screening, diagnosis, treatment, and management for SUDs is guided by overarching policies laid out by DoD, as