# TriCare , the VA and shipment of medications



## Stephen51

Hello, I am new to this site. I have gained a lot of knowledge. At this time no one has mentioned the Veterans Administration. It also has an Oversea's program. I am wanting to join it as I have medications that can be shipped but need to be kept refrigerated. I am still trying to find out about DOD capabilities. If it is similar to stateside it does not mail.

Stephen, USAF retired


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## Bevdeforges

Hi and welcome. I've moved your query into a new thread, since I think that may attract a bit more in the way of responses. Shipping medications can be a touchy area - if only for the "safety" factor of trying to keep something refrigerated during a long shipment process. There is also the matter of whether or not the particular medications are approved/used in France (or whichever country you move to in Europe). Though as I understand it, TriCare has a listing of their medical practitioners who would most likely be well aware of local restrictions and would prescribe medications available and acceptable locally.


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## Peasant

Stephen51 said:


> Hello, I am new to this site. I have gained a lot of knowledge. At this time no one has mentioned the Veterans Administration. It also has an Oversea's program. I am wanting to join it as I have medications that can be shipped but need to be kept refrigerated. I am still trying to find out about DOD capabilities. If it is similar to stateside it does not mail.
> Stephen, USAF retired


Is there a US Armed Forces facility you can get to? Even a train ride every three months to pick up medicine might be easier than trying to arrange refrigerated shipping.


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## Stephen51

Peasant said:


> Is there a US Armed Forces facility you can get to? Even a train ride every three months to pick up medicine might be easier than trying to arrange refrigerated shipping.


At the moment, Landstuhl, Germany. It's possible the Clinic in Belgium may have a good sized pharmacy. I do not know about Spain yet. I am looking at Pau, France as my first living area. If the VA Foreign Residence program is mailing from Europe then Cooled shiping by UPS/Fedex 2 day is possible. Whoever mentioned medications not sold in Europe is Spot-on. I take Pioglitizone and I read it was withdrawn from European markets. That may have changed.


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## Bevdeforges

I may be the one who mentioned medications not sold or approved here in Europe. One thing to consider is that, going forward, you will become eligible for the French health care system after 3 months of residence. You may want to consider registering with CPAM when you are eligible and using TriCare (or whatever VA program you are on) primarily as a "mutuelle" - in which case, you may want to go with what a French doctor prescribes.

There are a few products that have been withdrawn from European markets (or from the French market) since I've been living here. One thing I was taking was withdrawn because of a ruling that it was no more effective than the available "second choice" and had been shown to have more and more severe side effects. My husband just had to go back to his doctor to request a change in his medication because what he had been taking is no longer available in France - probably for similar reasons, although he's not one to ask about that sort of thing. I know that some medications are removed from the market here or not approved in the first place if they are no more effective than the existing treatment but are significantly more expensive. The increase in pricing has to be consistent with some improvement in results or efficacy. 

It's another of those "unexpected" aspects to being an expat.


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## 255

@Stephen51 -- To caveat, I've not participated in the VA's Foreign Medical Program, although I have participated in the VA's regular medical program in the States. The FMP has limitations. It can only be used for medical necessary treatments for VA-rated service-connected disabilities or conditions stemming from a rated disability. A VA pdf for your review: https://www.va.gov/COMMUNITYCARE/docs/pubfiles/programguides/FMP_Guide.pdf# . My understanding is the VA will only ship to U.S addresses (including territories.) This includes APO/FPO addresses. Additionally, all medications must be FDA approved and they will not ship medicines to countries, if the medication is not approved for use in that country.

As far as obtaining medical services at a Military Treatment Facility (MTF) overseas, it's hit or miss. First of all, retirees only get service on a "space-available" basis and then only if it's allowed under the relevant "Status of Forces Agreement." Each country has a separate SOF Agreement and these can sometimes change. Germany is much more restrictive, than lets say Spain. Additionally, change in a Commander can restrict service to retirees, for any reason (or none.)

As I'm sure you know the current Tricare mail order pharmacy is Express Scripts -- unfortunately they don't service expats.

Personally, I'd get a "vacation top-up" to your prescription before you travel, then see a local physician for a renewal (also register for the French National Medical system, after 3 months residency.) You can always utilize Tricare Overseas: 
https://www.tricare-overseas.com/ for reimbursement. I used Tricare Overseas in many different countries and they have always paid 100% of my costs (probably because medical costs overseas are so much lower than the U.S.) Once you are registered in the French system (which only pays 70%,) you can use Tricare Overseas, as a supplemental plan (remember Tricare is always last payer.) If your condition is considered chronic, France may pay 100.%. The only issue with Tricare Overseas is you have to make payment first, then file a claim. No direct billing your providers, like in the U.S. Cheers, 255


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## 255

@Stephen51 -- Just another point: if you ultimately want to try the MTF Pharmacy route, you should call the pharmacy you're considering directly (either commercially or go to you nearest military installation and finagle a DSN line.) Each pharmacy has a "formulary," basically a list of all medicines they carry. Often times, they'll have a substitute they can clear with the prescribing physician or, they can use a different dose. Say your doc. prescribes a 20 mg dose and all they carry are 50 mg, then the doc can alter the dose to 25 mg and you'll have to cut the 50s in half. Alternately, if you need a 100 mg dose and they only carry 50 mg tabs, you can double up. You can also check if they'll even serve a retiree and what docs. they'll accept a script from (they may not take a Stateside doc.)

Additionally, they may not even carry the meds. you're seeking, at all -- in which case you'll need to go on the economy anyway. I still think Tricare Overseas is your best bet. Cheers, 255


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## Stephen51

I have done more research on the VA Foreign Medical program. My biggest concern was obtaining Cooled Medication. The VA-FMP will reimburse me for all meds associated with my VA rated illnesses. I can choose any Physician in France, pay up front, then send in my receipts for visits and Pharmacy or related care. They will pay 100% of costs. Eur-$$ conversion on day of care. That was an unexpected benefit.


255 said:


> @Stephen51 -- Just another point: if you ultimately want to try the MTF Pharmacy route, you should call the pharmacy you're considering directly (either commercially or go to you nearest military installation and finagle a DSN line.) Each pharmacy has a "formulary," basically a list of all medicines they carry. Often times, they'll have a substitute they can clear with the prescribing physician or, they can use a different dose. Say your doc. prescribes a 20 mg dose and all they carry are 50 mg, then the doc can alter the dose to 25 mg and you'll have to cut the 50s in half. Alternately, if you need a 100 mg dose and they only carry 50 mg tabs, you can double up. You can also check if they'll even serve a retiree and what docs. they'll accept a script from (they may not take a Stateside doc.)
> 
> Additionally, they may not even carry the meds. you're seeking, at all -- in which case you'll need to go on the economy anyway. I still think Tricare Overseas is your best bet. Cheers, 255


Thank you for taking the time to write such a complete answer. I would only us DOD as a last resort. Having worked in Military Treatment Facilities squeezing in retiree's for Space A treatment was difficult. Tricare Overseas will be my next research project.


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## Stephen51

Someone Posted an address for Tricare in Seaside California. They stated that was the contact for Tricare letter of Coverage for TFL. Could you repost that address or cut and paste? I cannot find the old post. Thank you.


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## 255

@Stephen51 -- I did not make that original post you're referencing, but the following is a link to the Tricare Contact Page:

View All Phone Numbers | TRICARE .

I've never received a "Tricare letter of Coverage for TFL," but I did receive a coverage letter from Tricare Overseas when I was younger. Unfortunately, Tricare or TFL is not sufficient to qualify for French visa purposes. You'll need private health cover -- there have been numerous threads coving this topic. I think "repatriation" is the major "deal killer" for TFL. Most folks obtain suitable coverage and cancel it after qualifying and enrolling into the French National system. You could then use TFL as your supplement. Cheers, 255


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## Stephen51

255 said:


> @Stephen51 -- I did not make that original post you're referencing, but the following is a link to the Tricare Contact Page:
> 
> View All Phone Numbers | TRICARE .
> 
> I've never received a "Tricare letter of Coverage for TFL," but I did receive a coverage letter from Tricare Overseas when I was younger. Unfortunately, Tricare or TFL is not sufficient to qualify for French visa purposes. You'll need private health cover -- there have been numerous threads coving this topic. I think "repatriation" is the major "deal killer" for TFL. Most folks obtain suitable coverage and cancel it after qualifying and enrolling into the French National system. You could then use TFL as your supplement. Cheers, 255


Speaking of Repatriation, I read that the American Hospital in Paris can arrange Air Evac to the States. I would think with VA, TFL coverage and Air Evac that would make the Insurance question for the Visa a done deal.


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## 255

@Stephen51 -- Perhaps an argument can be made; but from a practical perspective, I haven't read of anyone being successful, at least using the TRICARE for Life certificate of coverage letter, in France, in recent times (the rules do tend to change over time.) I do know, along time ago, a TRICARE certification letter by itself met the requirements, but not in decades. All the retired military, that have made posts on this forum recently, were successful with private health cover, that they cancelled after becoming enrolled in the French National Heath Program.

I personally have used the TRICARE Certification Letter, as proof of healthcare in other countries and have lived successfully in those countries with TRICARE as my sole medical plan, but not France (other than trips as a non-resident.)

You can always make your case to the French authorities and if you're successful, please report back, so that others can duplicate your success. Cheers, 255


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## Bevdeforges

Stephen51 said:


> I read that the American Hospital in Paris can arrange Air Evac to the States. I would think with VA,


I wouldn't make that sort of an assumption. The American Hospital in Paris is a private hospital - and often not covered by many mutuelles and/or private insurers here in France. (You're always advised to contact your insurer before seeking treatment there, particularly hospitalization.) They have no formal affiliation with the US government, military or any other branches of government.

The big draw for the American Hospital is that they have staff who speak English (also Japanese and Arabic) but they are a private hospital and are known for charges well in excess of the CPAM standards (hence the need to clear treatment there with your mutuelle before you go there).


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## Stephen51

Bevdeforges said:


> I wouldn't make that sort of an assumption. The American Hospital in Paris is a private hospital - and often not covered by many mutuelles and/or private insurers here in France. (You're always advised to contact your insurer before seeking treatment there, particularly hospitalization.) They have no formal affiliation with the US government, military or any other branches of government.
> 
> The big draw for the American Hospital is that they have staff who speak English (also Japanese and Arabic) but they are a private hospital and are known for charges well in excess of the CPAM standards (hence the need to clear treatment there with your mutuelle before you go there).


I wouldn't expect my Insurance to cover Air-Evac. There is Air Evac insurance available as a stand alone policy. The Home web page for the American Hospital in Paris has an entire section on 24/7 Evacuation. Still in the final draw you are right about just getting a Mutuelles. I saw one for $19/day, more for me over age 70. To think In used to fly Medevac's!


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## Stephen51

A big Thank you, to whomever mentioned the Tricare Top-up Rx refill. It does exist and can be used twice a year. I am in Contact with the VA to see if they have a similar program. I'll report back.


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## Stephen51

I spoke with my VA Pharmacist. He said they may be able to refill a Prescription early for me. He did not know about VA Foreign Medical program. I will research that in more detail.


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## samiamiamiam

255 said:


> @Stephen51 -- To caveat, I've not participated in the VA's Foreign Medical Program, although I have participated in the VA's regular medical program in the States. The FMP has limitations. It can only be used for medical necessary treatments for VA-rated service-connected disabilities or conditions stemming from a rated disability. A VA pdf for your review: https://www.va.gov/COMMUNITYCARE/docs/pubfiles/programguides/FMP_Guide.pdf# . My understanding is the VA will only ship to U.S addresses (including territories.) This includes APO/FPO addresses. Additionally, all medications must be FDA approved and they will not ship medicines to countries, if the medication is not approved for use in that country. As far as obtaining medical services at a Military Treatment Facility (MTF) overseas, it's hit or miss. First of all, retirees only get service on a "space-available" basis and then only if it's allowed under the relevant "Status of Forces Agreement." Each country has a separate SOF Agreement and these can sometimes change. Germany is much more restrictive, than lets say Spain. Additionally, change in a Commander can restrict service to retirees, for any reason (or none.) As I'm sure you know the current Tricare mail order pharmacy is Express Scripts -- unfortunately they don't service expats. Personally, I'd get a "vacation top-up" to your prescription before you travel, then see a local physician for a renewal (also register for the French National Medical system, after 3 months residency.) You can always utilize Tricare Overseas: https://www.tricare-overseas.com/ for reimbursement. I used Tricare Overseas in many different countries and they have always paid 100% of my costs (probably because medical costs overseas are so much lower than the U.S.) Once you are registered in the French system (which only pays 70%,) you can use Tricare Overseas, as a supplemental plan (remember Tricare is always last payer.) If your condition is considered chronic, France may pay 100.%. The only issue with Tricare Overseas is you have to make payment first, then file a claim. No direct billing your providers, like in the U.S. Cheers, 255


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## samiamiamiam

The VA pharmacy WILL NOT deliver to an APO/FPO address, they will only deliver to the United States and the territories. I have gone round and round with the VA/USPS/FedEx/UPS/DHL. VA will not deliver to a foreign country, even FPO/APO. USPS is the only entity that will deliver to an FPO/APO, they require your doctor or pharmacy to ship meds. Well, that doesn't really work if your pharmacy is the VA which will not ship outside the U.S. UPS/FedEx/DHL are not permitted to deliver to FPO/APO, but have not problem shipping prescriptions given you have all your paperwork in tact. The nightmare circle is REAL! So the person who said APO/FPO is included in the U.S. addresses is incorrect.


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