Tricare pharmacy program recovers from rocky beginning

A retail pharmacy program under the military's Tricare health insurance system got off to a slow start June 1 when a software problem caused substantial delays in prescription drug processing.

The problem is now resolved, said Steve Littlejohn, vice president of public affairs for Express Scripts Inc., which is providing the service. The glitch was identified by June 2 and ESI began working immediately to remedy the problem. The Defense Department did not return calls for comment about the situation.

The program allows Tricare beneficiaries to fill prescriptions using network retail pharmacies if a drug is not available at a military treatment facility. Program beneficiaries can get 30-day supplies of prescriptions with a $3 co-payment for generic drugs and a $9 co-payment for brand-name drugs.

Littlejohn said the software situation was not a result of too many submissions, but rather just an unexpected processing issue that the provider was unable to detect during testing. "Sometimes, no matter how much you test a system, a problem can manifest itself once you get up and running," he said.

An online update on the Tricare Web site says that ESI has resolved most processing problems, but warns that intermittent delays could still occur. Defense says ESI is handling them on a case-by-case basis by communicating with the more than 53,000 pharmacies involved in the program. The online status report is updated every three days.

Littlejohn said that while the software issues did temporarily inconvenience pharmacies and beneficiaries, the provider is working hard to minimize nuisances. He said ESI asked pharmacies to fill prescriptions and process the paperwork later if they encountered problems to ensure people still received their medications.

Tricare processed more than 180,000 claims daily during the first week. That's 55,000 more than average, according to the Defense Department.

ESI is also the provider for the Tricare Mail-Order Pharmacy program, which has been in place since October 1997. This program allows beneficiaries to order 90-day supplies of their regular medication. The co-payment for the 90-day supply is equal to that of a 30-day supply pharmacy submission.

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