Changes coming to TRICARE prime services areas. Defense Department health officials announced that effective Oct. 1, TRICARE Prime will no longer be available to beneficiaries living in certain areas in the United States.Prime service areas were created to ensure medical readiness of the active duty force by augmenting the capability and capacity of military hospitals and clinics.The affected locations are not close to existing military hospitals or clinics and have never augmented care around military hospitals or clinics or Base Realignment and Closure locations.The plan to reduce prime service areas is not new. It originated in 2007 when the Pentagon solicited proposals for the next generation of TRICARE contracts.However, complications with the new contracts caused a delay in transition. Accordingly, defense officials determined that existing prime service areas be kept in place until all regions could fully transition to the new contract requirements.In a news release, Pentagon officials said that if you live in an area affected by the changes, you will receive a letter that will include information about your TRICARE health care options as well as how to get more information.Even if TRICARE Prime is no longer available where you live, you will still be able to use the TRICARE Standard and Extra options which have no enrollment fees. Both allow the freedom to see any TRICARE-authorized provider for routine or specialty care.An assigned primary care manager is not required, and cost shares for a wide range of preventive medical services have been eliminated.With TRICARE Extra, you choose hospitals and providers within the TRICARE network, where available, and pay a lower cost share.The news release outlined how different groups of beneficiaries may be affected:Active duty service members, including activated National Guard and reserve members, will not be affected by prime service area reductions. They will remain enrolled in TRICARE Prime or TRICARE Prime Remote, as appropriate.Active duty family members in affected areas will remain in TRICARE Prime as long as they are in the same location and eligible. As always, active duty family members also have the option of using the TRICARE Standard and Extra health plan option.Retirees and their family members in the affected areas may be able to reenroll in TRICARE Prime at a military hospital or clinic or with a primary care manager in a remaining prime service area.A new enrollment form will be required with an acknowledgment that the beneficiary is waiving their drive-time standards. Beneficiaries should be aware that waiving drive-time standards may require them to drive long distances for primary and specialty care.Those who do not reenroll in TRICARE Prime can use TRICARE Standard and Extra.If you are a surviving spouse of a deceased active duty service member, how your coverage may change depends on your survivor status.Transitional survivors [first three years following sponsor’s death] will remain in TRICARE Prime as long as they continue to live in the same location and remain eligible for TRICARE.After three years, surviving spouses TRICARE Prime enrollment will end, but they may be able to reenroll at a military hospital or clinic or with a network primary care manager in a remaining prime service area by waiving TRICARE Prime access standards.If they do not reenroll in TRICARE Prime, they will be able to use the TRICARE Standard and Extra health plan option.Surviving children are treated like active duty family members and can remain enrolled in TRICARE Prime [as long as they continue to live in the same location] until they otherwise lose eligibility for TRICARE.Young adults whose sponsors are active duty service members will not be affected. Other young adults with TRICARE Young Adult (TYA) Prime in the affected areas may be able to waive their drive-time standards and fill out a new enrollment form.Those who do not reenroll in TYA Prime can purchase coverage under TYA Standard.Affected beneficiaries may also have the option to enroll in the U.S. Family Health Plan, a TRICARE Prime managed care option available through networks of not-for-profit health care systems in six areas of the United States.Those already using TRICARE for Life, TRICARE Reserve Select, TRICARE Retired Reserve, or TRICARE Standard and Extra will not be affected.The Defense Department estimates that of the approximately 1.6 million retirees and family members currently in Prime, 171,000 will be affected.They also estimate that the change will save the government $45-$56 million a year.Pharmacy prices higher. The fiscal 2013 National Defense Authorization Act included a provision that allowed an increase in co-pays for prescriptions drugs covered by TRICARE. The new co-pays were effective Feb 1.There is no increase to co-pays for generic medications. It will remain at $5 when the prescription is filled at a network pharmacy.There is also no co-pay when generic prescriptions are filled through TRICARE’s home delivery service. The new co-pay for a 30-day supply of a brand name medication purchased at a retail network pharmacy will be $17, up from the current $12. Beneficiaries using TRICARE’s home delivery service will pay $13 for brand name drugs, up from $9. However, that price is for a 90-day supply.The greatest change in co-pays applies to non-formulary medications. The $25 co-pay for these drugs increases to $44 at retail pharmacies and $43 through Home Delivery.For fiscal 2014 and beyond, the new law directs that copays increase annually by the same percentage as retiree cost-of-living adjustments. In years when a COLA increase would total less than a dollar, it will be delayed a year and combined with the next adjustment so increases will always be $1 or more.Pharmacies at military hospitals and clinics will continue to provide medications with no copays.While the Defense Department had requested much higher co-pays, Congress disagreed.However, they included a requirement that all TRICARE-For-Life beneficiaries will be required to have all of their maintenance drugs refilled, for at least a year, through the home delivery program or at base pharmacies. This effort has not started yet.AUSA will keep you informed as TRICARE rolls outs its education program.