[HEALTH.MIL] TRICARE Enrollees Soon Will Have to Refill Certain Drugs Via Mail or at Military Facilities

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  • Date: Tue, 11 Aug 2015 11:11:55 -0500

TRICARE Enrollees Soon Will Have to Refill Certain Drugs Via Mail or at Military

By <http://www.govexec.com/voices/kellie-lunney/2348/> Kellie Lunney

August 10, 2015

Beginning on Oct. 1, TRICARE beneficiaries will have to obtain refills for
certain drug prescriptions through the mail, or at military treatment
facilities, according to a
nce> new interim final rule from the Defense Department.

The new policy affects refills of non-generic prescription "maintenance
medications," or drugs that people take on a regular basis for chronic
conditions, such as high cholesterol or blood pressure. The change does not
apply to medications for sudden infections or illnesses. The head of the Defense
Health Agency will maintain and update a list of covered medications, available
online or by telephone, and agency will contact eligible beneficiaries about the
change, stated the rule, published on Aug. 6 in the Federal Register.

The change, mandated by the 2015 National Defense Authorization Act, aims to
save money for the department and TRICARE enrollees by avoiding the higher drug
co-payments associated with many prescriptions medications in retail pharmacies.
The department estimated that the change will save the government roughly $88
million annually, while TRICARE beneficiaries will save about $16.5 million per
year because of cheaper co-payments.

"On average, the government pays 32 percent less for brand name maintenance
medication prescriptions filled in the mail order program or military treatment
facility pharmacies than through the retail program," the interim rule said. Not
all prescriptions refilled through the retail program are maintenance
medications, Defense noted, but nevertheless there is "potential for significant
savings" by shifting a portion of those TRICARE refills out of retail. In fiscal
2014, 61 million prescriptions for TRICARE beneficiaries were filled through
retail pharmacies at a cost of $5.1 billion to the government.

TRICARE beneficiaries can save $44 on a 90-day supply of brand name drugs by
obtaining them through the mail rather than retail pharmacies. The cost through
the mail for a 90-day supply of non-generic drugs is $16 versus $20 for a 30-day
supply in retail pharmacies. There are no co-payments on drugs obtained at
military treatment facilities.

Click <http://www.tricare.mil/pharmacycosts> here for a comparison of
prescription drug costs for TRICARE beneficiaries through mail, military
treatment facilities, and retail pharmacies.

In addition to exemptions to the new policy for prescription drugs for acute
needs and those covered by other health insurance, other waivers will be granted
in "several circumstances," the rule said. For instance, "there is a
case-by-case waiver to permit prescription maintenance medication refills at a
retail pharmacy when necessary due to personal need or hardship, emergency, or
other special circumstance, for example, for nursing home residents."

TRICARE prescription drug co-payments reportedly have emerged as a
d-retirement-copays/30879343/> major sticking point in negotiations between
House and Senate conferees over the fiscal 2016 Defense authorization
legislation. The Senate version of the bill includes provisions that would
increase co-payments for certain prescription drugs, while the House bill did
not include the hikes.

On Feb. 1,
Increase.aspx> co-pays for many prescription drugs at retail pharmacies
g-price-hikes-pay-raises-benefits-2016-budget-and-more/104601/> increased by $3.
If Congress settles on an increase for fiscal 2016, it will be the third such
price hike for TRICARE beneficiaries in the last four years.

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SOURCE: GovExec.com News Release at

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