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Pills Capsules Tabs
Did You Know? Pharmacy Requirements

Did you know that US Family Health Plan members MUST use the Martin's Point Mail-Order Pharmacy or one of the Martin's Point Health Care Center Pharmacies in Portland, Maine and Portsmouth, New Hampshire for their maintenance medications?
Department of Defense TRICARE® policy requires that maintenance medications (prescription drugs that you take every day to treat chronic conditions) be filled through a Martin's Point Pharmacy. Luckily for members, that means cost savings and convenience!

How to order your maintenance medications through a Martin’s Point Pharmacy: 

When you are prescribed a maintenance medication that you will be taking regularly, you may get your first fill at a local in-network retail pharmacy. For refills, please have your prescribing provider send a 90-day-supply prescription to a Martin's Point Pharmacy. Some restrictions apply. Some liquids, refrigerated items, and controlled substances cannot be mailed.
EXCEPTIONS—Members may fill the following kinds of prescriptions at an in-network retail pharmacy:

  • New (first fill) prescriptions for maintenance medications
  • Medications for urgent/acute needs (such as antibiotics)
  • Medications only taken when needed (PRN)
  • Dosage changes (Some maintenance medications require dosage adjustments to find the right dose)
  • Class II Narcotics

Important note: Please be aware that if you do not set up your maintenance medication at the Mail-Order Pharmacy or one of the Martin's Point Health Care Center Pharmacies in Portland, Maine or Portsmouth, New Hampshire, you may be required to pay the full cost of the prescription. This cost is not reimbursable.
Please contact one of the Martin's Point Pharmacies to set up your prescriptions to ensure the lowest cost.

  • Martin's Point Mail-Order Pharmacy: 1-800-707-9853.
  • Martin's Point Health Care Center Pharmacy, Portland, ME: 1-888-408-8281
  • Martin's Point Health Care Center Pharmacy, Portsmouth, NH: 1-603-436-0562
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Referrals
Referrals and Authorizations: What’s the Difference?

What are Referrals?

Your PCP is responsible for coordinating all your health care services except for life-threatening emergencies, annual eye exams, annual physicals, urgent care, and select mental health services. If your medical condition requires the service of a specialist, your PCP will send a referral to the specialist designated to perform that service for you. The referral is this communication between your provider and a specialist; your health plan does not need to be notified of referrals. Referrals from your PCP for specialty services are REQUIRED by the US Family Health Plan, except for those services for which you can self-refer (see below). 

NOTE: A referral from your PCP or another referring physician does not imply or guarantee coverage or payment by the US Family Health Plan.

Self-Referrals:

There are a few services you may obtain without receiving a referral from your PCP:

  • Emergency care for treatment of a potentially life-threatening condition
  • Urgent care for an illness or injury that is not life-threatening
  • Visits to a network provider for mental health or substance abuse treatment. To ensure that you make your appointments with a network provider, please contact Behavioral HealthCare Program (BHCP) by calling, toll-free, 1-888-812-7335 before your first appointment.
  • Annual routine exams such as, but not limited to, annual routine eye exams and annual preventive exams such as, but not limited to, annual mammograms

What are Authorizations and when are these needed?

Some services require authorization to determine if they are covered by the US Family Health Plan. This is sometimes also called “preauthorization.” Authorization of a service by the Plan means that the Martin’s Point Health Management Department has reviewed a request for a service and has determined that the requested service is both medically necessary and is a covered benefit under the Plan. It is your provider’s responsibility to request authorization from the US Family Health Plan to ensure that the Plan approves the delivery of the proposed service and will cover it.

You do not necessarily need authorization from the Plan for every referred service. 

How can you find out if the Plan requires authorization for a particular service?

To find out which services require authorization prior to delivery you may do the following:

  • Call Member Services, toll-free, at 1-888-674-8734 (TTY: 711).
  • Ask your PCP to find out, on your behalf.
  • For preauthorization of mental health and substance abuse services, please call the Behavioral HealthCare Program, toll-free, at 1-888-812-7335.
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Annual Breast Cancer Screening

Did you know? The US Family Health Plan covers a routine annual mammogram screening for persons 40+ years of age at no cost. No PCP referral is needed for this screening. Talk to your PCP about how frequently you should have this screening and take advantage of a benefit that could save your life!

Note: 3D mammograms (digital breast tomosynthesis) are not covered by TRICARE for routine screenings.

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Traveling/Out-of-Area Coverage

When traveling outside the US Family Health Plan service area, it’s comforting to know that we’ve got you covered. The information below explains how your coverage works for emergency, urgent, and nonurgent and routine care when you or a covered family member is away from home.

Worldwide Coverage: You have coverage worldwide (inside the US and out) for qualified emergency and urgent care services. If you have a qualifying medical emergency, go immediately to the nearest emergency room. You must notify your primary care provider (PCP) as soon as possible, as they must coordinate any necessary follow-up care. If you are traveling outside the US, notify your PCP as soon as possible upon your return.

Coverage in the United States: If you are traveling in the United States outside of the Martin’s Point US Family Health Plan service area, you may use your Point of Service (Out-of-Network) benefit for the following nonemergency/nonurgent services:

  • Routine office visits and lab work
  • Routine treatment for a chronic condition
  • Follow-up care, for example, physical or occupational therapy related to a covered emergency situation
  • Equipment or supplies necessary to treat a chronic condition

We strongly recommend that you contact Member Services before receiving nonurgent/nonemergency care from an out-of-network provider as your costs can be much higher under the Point of Service benefit.

IMPORTANT NOTE FOR MEMBERS WHO ALSO HAVE MEDICARE PART B COVERAGE:
You cannot use your Medicare to pay for care that is normally covered by the US Family Health Plan (or would be covered if you were in the service area). Intentional use of Medicare outside the US Family Health Plan service area for benefits that are covered by the US Family Health Plan (or would be covered if you were in the service area) is known as “Medicare Leakage.” Intentional Medicare Leakage results in automatic disenrollment from the US Family Health Plan.

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Need Fast Medical Care? Choose the Best Option!

When you need care quickly, the guide below can help you choose the best option, depending on how severe your condition or injury may be.

YOUR PRIMARY CARE PROVIDER (PCP): PCPs offer acute-care appointments during regular business hours. For non-life-threatening issues, a quick call to your PCP first may be your best option to get care for acute and chronic conditions, including colds and flu, minor injuries, high blood pressure, depression, and diabetes, just to name a few. And, you'll get care from someone who knows your medical history, current medications, and unique health needs.

URGENT-CARE CLINICS: Urgent-care providers can respond quickly to a variety of non-life-or-limb-threatening illnesses and injuries if your PCP office is closed (after hours/weekends) or is unable to see you in a timely manner. Go to a local urgent-care clinic instead of an emergency department if you have:

  • Sprains, muscle strains                
  • Fever, minor infections                 
  • Rash, minor burns/cuts
  • Cough/sore throat/sinus pain and congestion
  • Non-severe nausea/vomiting/diarrhea, etc.

EMERGENCY ROOM (ER): ERs are the best choice when conditions are life-or-limb-threatening and may require advanced treatment. Hospital ERs are open 24 hours daily and offer access to specialists. The average ER wait time for non-emergencies is 90-120 minutes.

Go to your nearest ER if you have:

  • Chest pain
  • Uncontrolled bleeding
  • Signs of stroke—sudden weakness, difficulty speaking, or severe headache
  • Unusual shortness of breath
  • Severe abdominal pain

Always follow up an ER or urgent-care visit with a visit to your primary care provider (PCP).

24-HOUR NURSE LINE: The nurse line—free to US Family Health Plan members—is a great resource for after-hours questions about non-life-threatening injuries or illnesses. Call 1-800-574-8494 day or night to speak with a registered nurse who can guide you to the right place for your care needs.

What are the benefits of getting your care from a PCP?

Your PCP should be seen at least once a year for a preventive care visit. They can also help you manage your chronic conditions and acute illnesses as they arise. Your PCP:

  • Knows your medical history and can notice small changes to your health
  • Works with you and provides education to improve your health over time
  • Knows all your medications and can help avoid harmful interactions and overmedicating
  • Knows you as a person and gets to know your preferences for your health
  • Coordinates preventive screenings to identify and address concerns early
  • Collaborates with your specialists to make sure your care is well coordinated

Visit our website to view the Urgent Care and Walk-In Care Directory
Martinspoint.org/urgentcare

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Is Your Blood Pressure Reading Correct?

High blood pressure, also called hypertension, is one of the most common chronic diseases and is a major risk factor for multiple conditions. To ensure early detection and treatment, it’s important to have regular blood pressure checks. It’s also important that your blood pressure readings are as accurate as possible. Here are a few tips on what you can do to help make sure your blood pressure readings are correct:

Blood Pressure Tips

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Getting Behavioral Health Support When You Need it

Being able to connect with a counselor when you need one is important to you and your family.  Members of the US Family Health Plan can reach out to our partner, the Behavioral HealthCare Program, for help finding a qualified provider. Please call during business hours at 1-888-812-7335 (the number is also on the back of your Member ID card) or go to their website at https://www.bhcp.org/ContactBHCP.aspx for more information.
It may take a few weeks to locate a provider who is a good fit for you and your needs. In the meantime, you can contact your primary care provider (PCP) to report symptoms, or you can use national and state organizations that provide immediate help.
If there is an emergency, or crisis for yourself or a loved one, please refer to the following resources:
Call 911 or the 1-800-273-8255 for the National Suicide Prevention Lifeline that is ALWAYS AVAILABLE

  • Maine:  https://www.maine.gov/dhhs/hotlines.htm
  • New York:  https://omh.ny.gov/omhweb/bootstrap/crisis.html
  • New Hampshire:  https://www.dhhs.nh.gov/dcbcs/bbh/centers.htm
  • Vermont:  http://vtspc.org
  • Pennsylvania:  https://www.namikeystonepa.org/support/nami-helpline-crisis-line/
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Has Your Health Care Team Huddled Lately?

Collaborative Care: Promoting Communication Between Primary Care and Behavioral Health Care Providers

Just like with sports or business teams, when it comes to your health, communication and collaboration among team members are key to achieving goals. The best care happens when your behavioral health and other specialty providers work as a coordinated team with you and your primary care provider (PCP) at the center. Research shows that good things happen when PCPs are actively informed about all specialty care--symptoms decrease, health goals are achieved, and people feel they are getting the quality care they deserve.
Team approaches are sometimes called collaborative care, integrated care, or health homes and these models are showing positive results in improving care.  Below are two important examples:

  • Medication—Updates between your PCP and behavioral health provider about medication changes can help avoid harmful drug interactions.
  • Reporting symptoms and diagnosing—For example, depression symptoms can be caused or made worse by a thyroid condition or a major life event such as the loss of a loved one. As an integrated team, your PCP can “huddle” with your behavioral health providers to determine the root cause of your symptoms and guide the care plan to reduce painful depression symptoms.

Ask your team to step up to the plate…we can help!

It’s your right as a patient to request that your behavioral health providers and your PCP coordinate with each other to ensure the best treatment. At Martin’s Point, we value coordinated care and can help you develop a team approach with your providers. If you would like to know more or need help in making sure your providers are communicating about your care, please call our Care Management line at 1-877-659-2403. Please leave a message with your name and date of birth and one of our care managers will reach out to you. We are here for you!

What can YOU do to get your health care team to “huddle” more often?

You can start taking action today to lead your team to success. Follow these five simple steps:

  • Keep a health diary and bring it to every provider visit. In it, keep important dates/times, an updated medication list, and contact info for your team “roster” so you can easily share medication and treatment plan updates with your various providers at each visit.
  • Sign releases allowing your providers to exchange information. (Note: each provider has their own release forms where you can choose the information you want shared. You can cancel the release at any time with no consequence.)
  • Ask your PCP and behavioral health provider to seek updates and records from each other.
  • Anytime there is a medication change by any provider, ask them to share that information with the other team providers. You can also directly report all medication changes to your PCP. Along with you, they are the co-captains of your team.
  • When starting with a new provider, identify them as a team member with the other team providers. Share contact information with all providers and ask for coordination of care.

https://www.integration.samhsa.gov/integrated-care-models
https://www.nimh.nih.gov/health/topics/integrated-care/index.shtml

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Breast Pump Reimbursement Rates Have Changed

TRICARE® reimburses up to a set amount for a breast pump and initial breast pump kit (rates may change annually). As of March 2019, the rates have changed to $312.84 (stateside) or $500.55 (overseas). You can find the rates at www.Health.mil or call Member Services at 1-888-674-8734 for information.
Visit www.MartinsPoint.org/TRICARE to find a participating provider and the required reimbursement form:

  • Providers & Hospitals—click Hospitals and Facilities and choose Durable Medical Equipment. You then can search by name or address
  • Member Toolkit—Member Reimbursement Request forms are available under the Member Document section

Looking for more information on supplies covered by TRICARE? Please visit: www.tricare.mil/CoveredServices/IsItCovered/BreastPumpsSupplies or call Member Services at 1-888-674-8734.