Do you have other health insurance with pharmacy benefits?

Learn how coordination of pharmacy benefits works.

Coordination of benefits is available for US Family Health Plan beneficiaries who have other health insurance that provides added pharmacy coverage at retail pharmacies and our Martin’s Point Mail-Order Pharmacy. Be sure to provide both insurance cards to the pharmacy when you fill prescriptions. The pharmacy will submit your prescriptions to both insurance plans at the same time. Which plan pays first is determined by TRICARE rules, your other plan’s policies, and who the policy holder is (in most cases TRICARE pays after your other health insurance).

Benefits of coordination of your insurance plans include:

• Reduced or no out-of-pocket costs when your prescription is covered by both insurance plans
• Eliminates need to submit paper claims

Important information to remember:

• If your other health insurance is the primary payer and requires a prior authorization, you will need to seek prior authorization from them as well as from the US Family Health Plan (if we also require prior authorization).
• The US Family Health Plan will become the primary payer if your other health insurance does not cover the medication or if you have exhausted your other health insurance benefits for the year.
• The US Family Health Plan will be primary payer if your other health insurance is:
  • Medicaid or Medicare
  • TRICARE supplemental plan
  • Other federal health programs identified by the Defense Health Agency
• If your other health insurance prefers a certain retail or mail-order pharmacy, you will need to fill through their preferred pharmacy network. If they are unable to coordinate with the US Family Health Plan online, you may seek reimbursement for eligible out-of-pocket costs. For the drug reimbursement form, visit the Prescription Drug & Pharmacy page at martinspoint.org/USFHPPharmacy.