The TRICARE system offers generous healthcare coverage to active-duty service members, Reserves, and retired military families. The program provides coverage through a variety of plans, including TRICARE Prime and Select, US Family Health Plan, and TRICARE Reserve Select. These premium-based options offer a wide range of treatments and services with relatively low out-of-pocket costs compared to civilian plans.
TRICARE West covers mental health and substance abuse treatment. This includes applied behavior analysis, autism spectrum disorder treatment, aversion therapy, eating disorders treatment, cognitive rehabilitation therapy, and detoxification. TRICARE also covers behavioral health counseling for pregnant women and their partners.
The Defense Department announced in December that it has selected TriWest Healthcare Alliance Corporation of Phoenix to manage TRICARE’s new West Region. This region will include Alaska, California, Idaho, Oregon, Washington (except northern Idaho, which is managed by the existing Central Region contract), and Yuma, Arizona. The Government Accountability Office denied Health Net Federal Services’ second protest and affirmed the defense health agency’s selection of TriWest. The company is appealing the decision to the U.S. Court of Federal Claims.
Benefits of TRICARE West
TRICARE west offers benefits for active duty service members, retirees, and their families in 21 western states. These benefits include prescription drugs, health care services and equipment, dental and vision coverage, and more. In addition, TRICARE west offers beneficiaries access to telehealth providers and has a lower cost-share than civilian plans for some health services.
The program also provides a premium-based plan, TRICARE Reserve Select, which active status National Guard and Reserve members may purchase to pay for Medicare Part B costs. This plan requires a monthly premium and includes coverage similar to TRICARE Standard and Extra, except for some special needs services, such as applied behavior analysis, cancer clinical trials, durable medical equipment, and home health services.
The Defense Department is implementing new contracts, called the Next Generation of TRICARE, to improve military readiness, healthcare delivery, clinical quality, and beneficiary access. A dispute over the contract has halted its start, but the Defense Health Agency is confident that the new contracts will provide better customer service and make it easier for beneficiaries to transfer their specialty care referrals between regions when they move.
Tricare West Provider Network
The TRICARE provider network includes doctors, hospitals, and other providers. It also includes pharmacies and telehealth options. You can search for providers using your ZIP code or state and the name of the physician or facility. You can also find a TRICARE provider by type, location, and hours of operation. You can also search for a provider by first and last name.
TRICARE is a health care program administered by the U.S. Department of Defense Military Health System. It provides private healthcare treatment, referrals, customer service, and claims processing for 9.6 million beneficiaries, including active duty personnel, some members of the National Guard and Reserve, and retirees and their families. The TRICARE Management Activity organizes a network of three regional Managed Care Support Contractors, a Pharmacy Benefit Manager, and Mail Order Pharmacy contractors.
TRICARE Select Overseas beneficiaries can use the TRICARE telehealth tool to connect with a TRICARE provider for consultations by phone or video conference. This allows you to get the care you need without traveling. You can also receive care at a TRICARE Authorized Provider located on the grounds of a military base or post. However, if you choose to go to a freestanding emergency room, you should know that TRICARE requires that these facilities be affiliated with the hospital in order for TRICARE to reimburse your bill.
TRICARE WEST and Pharmacy Benefit Managers
TRICARE West is part of the Defense Health Agency and provides healthcare services to active duty military members, retirees, and eligible family members. It includes a managed care support contractor and three regional pharmacies and is supported by several contractors for customer service and quality management.
A pharmacy benefit manager (PBM) is a company that manages prescription drug plans on behalf of public and private insurers. While the primary function of a PBM is to provide patients with affordable access to medication, it also has the responsibility to prevent fraud and abuse. To do so, it is crucial for pharmacies to have accurate and up-to-date records of dispensed medications and purchased drugs.
As a result, pharmacists should be prepared for an audit by Tricare West. They must be able to prove that their dispensing practices are compliant with the terms of the PBM’s contract. Otherwise, a pharmacy may face significant sanctions. One of the most common violations cited during an audit is that a pharmacy has sold illegitimate prescriptions. This can be the result of a number of different errors, including double billing, upcoding, and selling samples or returned drugs.