German laws restrict mailing meds
February 27, 2013
LANDSTUHL REGIONAL MEDICAL CENTER, Germany (Feb. 27, 2013) -- All U.S. ID cardholders are reminded that prescription drugs, over-the-counter medications, vitamins/minerals, and herbal & dietary supplements are not allowed to be mailed through an Army Post Office to Americans living in Germany.
German law provides strict regulations for importing medicine into Germany from other countries. Prohibited medicine products identified by U.S and German customs officials can either be destroyed or returned to sender, according to German and U.S. postal and customs officials.
For those affected by the policy, there are options available to receive certain medicines and supplements, to include military treatment facility (MTF) pharmacies, AAFES outlets, commissaries, and German pharmacies and retail stores, said Lt. Col. Rodney Jorstad, pharmacy consultant for Europe Regional Medical Command. Below is a summary of various options provided by his office that is available to ID cardholders living in Germany.
The following are frequently asked questions regarding medication and German customs:
(1) I've never been to a military treatment facility. Do I need to register to have my prescriptions filled or can I come straight to the pharmacy?
To receive any services from an Army MTF, beneficiaries must first be registered in the Defense Enrollment Eligibility Reporting System (DEERS), a worldwide, computerized database of uniformed service members, their family members and others who are eligible for military benefits. This requires a visit to the Patient Administration (PAD) section, which usually occurs during inprocessing for active duty service member and their family members.
Pay patients (civilians, DoDEA/DoDDS staff and eligible contractors) or those with additional insurance coverage beyond Tricare (internally referred to as OHI or third-party insurance) are asked to provide insurance information to PAD during the initial registration process.
As this information can change over time, customers are responsible for making sure PAD has their most current insurance information or customers may be billed for 100 percent of the costs for any services rendered. Patients should have their insurance cards with them to ensure they're billed correctly. Once registered, they will be registered at all MTFs within Germany.
(2) After you register, what's required to have my prescription filled?
If you previously received your prescriptions in the mail, you will need a new written prescription from your health care provider to have your prescription filled at an MTF pharmacy. A label from your current mail order pharmacy is not sufficient. Mail order pharmacies will not transfer your prescription to military pharmacies.
Only original prescriptions (not copies or scans) are considered legal. This may require you to schedule an appointment with your local provider or contact a stateside provider for new prescription orders to be mailed to you.
When you arrive at a military pharmacy, you are required to show your ID card and present a hard copy prescription signed in ink by a physician. Patients need to bring their prescriptions to the pharmacy well before they run out of medication. If their prescription is for a medication that is not stocked, it can take between one to three weeks to fill the prescription and up to six weeks if it's a narcotic medication.
Army military treatment facilities do not have the ability to carry all medications available on the American market, and military treatment facilities are limited by their overseas supply chain when requisitioning medications. Delays may occur if your written prescriptions contain small errors or unclear information that requires a pharmacist to contact the provider before filling them.
Due to the time differences and availability of the provider, this may delay your prescription a few days after you present them to the pharmacy. If the pharmacist's questions cannot be resolved, the pharmacist may refuse to fill the prescription.
(3) Will military pharmacies be able to fill all prescription medications?
There are several FDA-approved medications that are not provided at MTF pharmacies due to policies or regulations that forbid their use within the military health care system. A prior authorization or any other approval from Tricare or a civilian insurance company does not override these restrictions.
Regardless of the reason you are using them, Army MTF pharmacies may not be able to honor your prescription. The most common restricted items include weight loss medications, fertility/assisted pregnancy medications and medications approved for cosmetic conditions. Call your local MTF pharmacy if you have any questions, as a complete list of these items cannot be provided here.
(4) How does the pharmacy system determine which prescription medications they will stock?
Army MTF pharmacies in Germany operate under one formulary system, which means that Army senior physicians and pharmacists decide which medications are generally available and locally stocked. The entire overseas supply system is based on providing formulary medications to the Army pharmacies. Providers may request a nonformulary (sometimes called special order) medication based on rules outlined by the military and Tricare.
These requests will be approved or denied based on a patient's individual circumstances and clinical criteria. Patients using nonformulary medications, who use stateside providers, will be encouraged to switch (with their doctor's permission) to similar formulary medications.
Prescriptions for nonformulary medications from stateside providers will be reviewed for approval by local clinic leadership. If approved, nonformulary medications typically take several weeks to arrive from the U.S. Some nonformulary medications are "restricted" and requests for these may be denied.
(5) How do I order refills of my medications?
All prescription bottles dispensed from an MTF contain a phone number to call to request refills. All you need to do is follow the automated prompts and enter the refill prescription number. Refills can be picked up at any MTF pharmacy in Germany.
(6) What about controlled substances?
Controlled substances can be filled by military pharmacies but they are subject to military service rules. Prescriptions for controlled substances filled at any Army pharmacy will be limited to a one month supply except for ADHD medications, which can be filled for a three-month supply.
(7) Can I fill prescriptions written by my German doctor?
Yes, as long as the doctor is a Tricare authorized provider. The prescription must be written in English using American trade names/generic names. The easiest way to find out if a local German doctor can write prescriptions is to ask if they are accustomed to writing prescriptions to be filled at an American military pharmacy.
(8) I've never seen a cash register at an Army pharmacy. How can civilians pay for their medications?
Civilian pay patients will be charged the entire cost of the prescription minus what their insurance pays. Europe Regional Medical Command (EMRC) has an office that will bill third-party insurance, accept any payment provided by that insurance, and bill patients for any remaining costs (usually co-pays/co-insurance, or applicable deductibles or not covered services). This is a courtesy provided by ERMC. The billing process for prescriptions is not handled by the pharmacy, and pharmacy personnel will not be able to answer billing questions.
All questions concerning claims (potential or actual) or any other billing issues should be directed to the ERMC Uniform Business Office (eUBO) at www.eubo.healthcare.hqusareur.army.mil.
Contact information can also be found at the bottom of each billing statement. The rates used by the eUBO for billing are defined by DOD pricing tables and are not developed locally. It is our experience that the cost of prescriptions billed by MTF pharmacies is comparable to stateside retail pharmacies.
Army MTF pharmacies can estimate the cost of a prescription but cannot estimate what your insurance will pay or estimate what your out-of-pocket expenses will be.
(9) What about non-prescription items such as over-the-counter medications, protein powder, vitamins/minerals, herbals and other supplements? And do the same mailing restrictions apply to medications for pets?
Army MTF pharmacies are unable to order nonformulary over-the-counter items, even if they were recommended by your doctor. Many local stores have these products available to purchase, including AAFES facilities, the commissary, the German Apotheke (pharmacy) or German retail stores such as Globus or Real.
The German medical system uses many more herbal and homeopathic medications than used in the U.S., so finding these products at German stores will likely be easier than you expect. The same mailing restrictions apply to medications for pet. Consult your local veterinarian for suitable alternatives.