US Family Health Plan eNews 2021 Issue 3
Posted 07/12/21
For more of eNews Member Newsletter
IN THIS EDITION:
TRICARE® 2022 Prescription Copay Increases
For your planning purposes, we want to let you know that TRICARE will be raising member copays on prescription drugs beginning January 1, 2022. These increases will affect all US Family Health Plan members except dependent survivors of active-duty service members (ADSMs), medically retired service members and dependents of medically retired service members. These members will see no change in their prescription drug copays in 2022.
2022 Prescription Copays
| Retail Network Pharmacies (e.g. Rite Aid, CVS, Walgreens) (up to a 30-day supply) | Martin’s Point On-Site and Mail-Order Pharmacies (up to a 90-day supply) |
|||
|---|---|---|---|---|
| Current | Effective 1/1/22 | Current | Effective 1/1/22 | |
| Generic (Tier 1) | $13 | $14 | $10 | $12 |
| Brand-Name (Tier 2) | $33 | $38 | $29 | $34 |
| Nonformulary (Tier 3) Brand and Generic |
$60 | $68 | $60 | $68 |
| Non-Covered Drugs (Tier 4) | 100% cost of the drug | 100% cost of the drug | 100% cost of the drug | 100% cost of the drug |
August is National Immunization Awareness Month
National Immunization Awareness Month was established to highlight the importance of vaccination in protecting the health of people of all ages. The Centers for Disease Control and Prevention (CDC) provides importance guidance about immunization schedules recommended for different age groups. Check out our convenient list of these recommended immunization schedules on our website today and make sure you and your family are up-to-date with your vaccines!
COVID-19 and Its Variants Are Still With Us
Make Sure to Get Vaccinated!
With relaxed restrictions on public gatherings, it’s more important than ever to protect your health. If you haven’t yet received your COVID-19 vaccine, we urge you to do so as soon as possible. TRICARE® covers COVID-19 vaccines for members of the US Family Health Plan. For information on the distribution and availability of the COVID-19 vaccine, please visit your state's CDC website. For the most up-to-date information, go to https://tricare.mil/HealthWellness/HealthyLiving/Coronavirus/COVID-vaccine.
Check out our new Mental Health webpage
As your partner in health, we at the Martin’s Point US Family Health Plan want to support your best health—physical and mental. We’ve launched a new Mental Health page on our website where you can find helpful information and resources, including topics like:
- Reasons to seek care from a mental/behavioral health specialist
- COVID-19 pandemic and stress
- Healthy ways to cope with stress
- The importance of follow-up care after a hospital discharge
- Pediatric mental health, including medication information for ADHD/ADD, psychosis, and more.
Kid Heading to College? Send the Martin’s Point US Family Health Plan with Them!
Is your student hitting the books at college this fall? For many eligible dependents, their US Family Health Plan coverage can follow them to college.
Normally, children are eligible for TRICARE® benefits until age 21. But coverage extends up to age 23 for unmarried children of TRICARE-eligible sponsors, if both:
- The child is a college student enrolled in a full-time course of study at an approved institution of higher learning AND
- The sponsor provides over 50 percent of the child’s financial support
If your student is heading to college, update the Defense Enrollment Eligibility Reporting System (DEERS) to reflect this status. This will verify and ensure their eligibility for TRICARE.
What you’ll need to do to extend benefits past your student’s 21st birthday:
- You’ll need to get a letter from the school registrar’s office stating that your child is enrolled full time in an accredited college in pursuit of an associate’s degree or higher. Bring the letter to a military ID card-issuing facility.
- To avoid automatic disenrollment when your child turns 21, you should update DEERS information before their 21st birthday.
- Be sure to call Member Services after your DEERS update to verify the extension of enrollment. You can reach them Monday through Friday, 8 am– 5 pm, at 1-888-674-8734.
Is your child between the ages of 21-26 and not a full-time student?
They may be eligible for coverage through the TRICARE Young Adult program. The TRICARE Young Adult (TYA) program is a premium-based health plan available for purchase by qualified dependents through the Martin’s Point US Family Health Plan. TYA includes medical and pharmacy benefits but excludes dental coverage.
Your adult-aged dependent may purchase TYA coverage based on the eligibility established by their uniformed service sponsor and where they live. Note: Special eligibility conditions may exist.
They may purchase TYA coverage if ALL the following apply to them:
- A dependent of an eligible uniformed service sponsor
- Unmarried
- At least age 21 (or age 23 if enrolled in a full-time course of study at an approved institution of higher learning and if the sponsor provides at least 50 percent of the financial support), but have not yet reached age 26
- Not eligible to enroll in an employer-sponsored health plan as defined in TYA regulations
- Not otherwise eligible for TRICARE program coverage
Remember, when your child travels outside the US Family Health Plan service area to attend college, only qualified emergency and urgent care are covered. An exception would be care received using the Point of Service (Out-of-Network) option. The Point of Service benefit allows you to receive non-emergency services from providers who are not in our network at an additional cost. Call Member Services for details. Examples of care that will not be covered by the US Family Heath Plan while they are out of the area include:
- Routine office visits and lab work
- Routine treatment for a chronic condition
- Equipment or supplies necessary to treat a chronic condition
Routine care (for example, physicals and routine lab work) should always be scheduled with your child’s in-network primary care provider (PCP) or specialist when they are home for school breaks.
For more information about dependent coverage, please call our Member Services team at 1-888-674-8734. If your child is ready to enroll in TRICARE Young Adult, please have them call 1-877-757-7087 and do not hit any prompts. They will reach one of our representatives to help them fill out the application over the phone.
Child/Adolescent Immunizations: Are Your Kids Up to Date?
Staying on top of important preventive health visits was often difficult during the pandemic. One of the hardest hit areas was pediatric immunizations. We are urging all US Family Health Plan members to make sure to schedule any vaccinations for their children that they may have delayed in the past year. Please see the newly added pediatric health resource on our website which includes recommended immunization schedules, along with recommended well-child visits, pediatric mental health resources, and more. Check out our Pediatric Health page for more information!
Women’s Health Resources: Catch Up on Your Preventive Care
If you’re like many people, you may have skipped important preventive health visits during the pandemic. We are urging all US Family Health Plan members to schedule any health care appointments that may have been missed in the past year. Please see the newly added women’s health resource on our website which includes information regarding recommended screenings for cervical, breast and colorectal cancers, in addition to chlamydia screening and other important women’s health topics. Check out our Women’s Health page for more information!
Do you need help to quit smoking?
Smoking-cessation products are covered by your health plan!
Cigarette smoking is the leading cause of preventable death in the United States.1 Although cigarette use has gone down significantly, CDC data from 2017 tells us that around 34 million American adults (or 14% of the population) admit to daily or occasional cigarette use.2
Quit attempts using medications tend to have better outcomes than those done “cold turkey,” or without medication. Products that help you quit smoking include nicotine-replacement medications (for example, gum and patches), varenicline (Chantix®), and bupropion SR (Zyban ®).
A 2020 US Surgeon General’s Report suggests that combining medications may increase the likelihood of quitting.3 One strategy for combining medications is to use a long-acting medication that you take on a regular schedule with a short-acting medication to help with cravings, as needed. Examples of long-acting medications include varenicline, bupropion, and the nicotine patch. Short-acting medications include gum, lozenges, inhalers, and nasal spray that contain nicotine.
The smoking-cessation products listed below are covered under your US Family Health Plan pharmacy benefit when filled at a Martin’s Point Pharmacy (not covered at outside pharmacies such as CVS, Walgreens, etc.).
- All of these medications are covered for members aged 17 or older at a $0 copay, and limited to 60-day quantities and two quit attempts per year. A quit attempt is considered a 120-day supply. If you need more than 240 days of medication, a prior authorization would be required.
| US Family Health Plan | |
|---|---|
| LONG-ACTING MEDICATIONS |
|
| Bupropion SR (Zyban®) Varenicline (Chantix®) Nicotine Patch |
$0 copay, 60-day quantity limit |
| SHORT-ACTING MEDICATIONS |
|
| Nicotine Gum Nicotine Lozenge |
$0 copay, 60-day quantity limit |
| Nicotine Inhaler Nicotine Nasal Spray (Nicotrol®) |
$0 copay, 60-day quantity limit |
If you need help to quit smoking, ask your doctor if using medication to help may be a good next step for you. Please see the TRICARE formulary
search tool for specific quantity limits.
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1. U.S. Department of Health and Human Services. Adult Cigarette Smoking in the United States: Current Estimate. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2012.
2. Wang TW, Asman K, Gentzke AS, et al. Tobacco Product Use Among Adults—United States, 2017. MMWR Morb Mortal Wkly Rep. 2018;67:1225–1232. doi: http://dx.doi.org.une.idm.oclc.org/10.15585/mmwr.mm6744a2.
3. Department of Health and Human Services. Smoking Cessation: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2020.
