October 2006

ARMED FORCES NEWS
TRICARE CATASTROPHIC CAP RESETS
October 6,2006


On Oct. 1, the Tricare catastrophic cap began anew for fiscal 2007. The cap limits out-of-pocket Tricar expenses to $1,000 for active duty individuals and families and $3,000 for all other Tricare beneficiaries during each fiscal year running from Oct. 1 through Sep. 30. It applies to all Tricare services, including deductibles, pharmacy copays, enrollment fees and other cost shares. Once a family reaches the cap, Tricare will pay the family's share of all Tricare expenses for the remainder of that fiscal year. The cap applies only to Tricare services and not to nonparticipating providers who may charge more than Tricare maximum allowable charges. It also does not apply to expenses paid under the Prime point-of-service plan.

 

ARMED FORCES NEWS
DEFENSE ACT DROPS TRICARE COST INCREASES
October 6, 2006
 

The fiscal 2007 defense authorization act includes a provision to prevent the Defense Department from increasing Tricare beneficiary costs such as Tricare Prime or Tricare Standard fees, Tricare Reserve Select premiums, or pharmacy copays. The ban, however, would apply only to fiscal 2007. The act also cancelled an earlier effort to require use of the TMOP (Tricare mail order pharmacy) for refills of maintenance drugs. In addition, it did not include previous plans to eliminate copays for drugs ordered through the TMOP and to require drug suppliers to give retail pharmacies price discounts similar to those given to the TMOP system.
 

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