TRICARE Changes in Singapore, Part 2

I just came back from our Singapore pharmacy.  The one that has stopped providing prescription drugs on a cashless basis to military families here because TRICARE has changed our health insurance plan in Singapore after sending out letters stating that nothing would change.  In fact, they made changes that caused doctors to leave the network and our pharmacy to end its cashless service.

Coincidentally, our pharmacy called me to ask me to pay $7 for a prescription that I had filled last December, almost nine months ago.  It was not covered because it was an over-the-counter product, but I found out a few interesting things about how our system works here.

I should first mention that our local TRICARE representative is great.  She is a Singaporean who knows her way around the medical system here and has done a wonderful job of getting us quality medical care during our time in Singapore.  My concerns are not with her but rather the TRICARE rules that she must follow.

Here is what I learned from the pharmacy:

• When it comes to being reimbursed for our prescriptions, the Singapore pharmacy must follow the United States formularies, not Singapore rules.  If a Singaporean doctor prescribes medication that is available over-the-counter in the United States, TRICARE will not pay for the prescription.  It does not matter that we do not have access to a U.S. drug store, although we do have many common medications available at our Navy Exchange.  Our local pharmacy says they have found many instances where they submitted a claim for reimbursement but it was rejected by TRICARE. Of course I cannot verify this.
• Unfortunately, it takes a very long time for the pharmacy to be reimbursed.  My most recent prescription drug claim, which I filled in mid-December, 2009, was probably submitted by the pharmacy’s corporate office to the United States in early to mid-January.  They did not receive a rejection notice until about August, 2010, at which point they called me to request payment.
• The pharmacy has a stack of unpaid prescription drug bills for drugs given to military families.  They know that service members are only stationed in Singapore for a short period.  They have found that some families have already left Singapore before the claim is rejected by TRICARE.
• Previously, to pick up a prescription we just had to fill out a claim form at the pharmacy.  In order to keep the system cashless, one possible work-around is that the pharmacy will have to contact our TRICARE representative prior to dispensing a prescription.  The TRICARE rep will then fax a claim form to the pharmacy.  From the pharmacy’s perspective, this adds a middleman and more work than they had to do before.  From the military’s perspective, my guess is that this would reduce the rejection rate of claims by pre-screening which drugs are covered under the U.S. rules.
• Under the new agreement, which has yet to be agreed upon, our prescriptions would expire within one to three months after being written.  I do not know how long they are good for right now, but my recollection is that in the United States a doctor’s prescription is often good for up to six months.  I am not sure what impact this would have on us, but it also probably would ensure that claims are submitted quickly.

In the end, I imagine that the Navy and the pharmacy will come to an agreement on how to make a cashless system work under the new rules.  I also acknowledge that I do not have the full story when it comes to how the pharmacy was submitting claims or if their claims were accurate. 

It concerns me that a drug prescribed by a Singaporean doctor might not be covered by TRICARE if it is available over-the-counter in the United States.  And my bigger concern with the recent changes is still the fact that TRICARE deleted the Guarantee of Payment of Medical Claims from our overseas health insurance.

Tagged as: International SOS, over-the-counter prescription drugs, pharmacy, Singapore, TRICARE, Wisconsin Physician Services