[HEALTH.MIL] Tricare Beneficiaries' Access To Brand-Name Drugs Would Be Limited

  • From: HEALTH.MIL@xxxxxxxxxxxxx
  • To: <HEALTH.MIL@xxxxxxxxxxxxx>
  • Date: Thu, 4 Dec 2014 11:31:06 -0600

Tricare Beneficiaries' Access To Brand-Name Drugs Would Be Limited

By Patricia Kime, Staff writer 3:37 p.m. EST December 3, 2014

Tricare patients who take brand-name drugs for chronic conditions may be
required to fill their prescriptions at a military pharmacy or by mail starting
next October.

Under the compromise 2015 defense authorization bill rolled out Tuesday by
Congress and likely to be signed into law in the coming weeks, the Defense
Department will require any Tricare beneficiary who uses non-generic
prescriptions for long-term conditions to get them at a military treatment
facility or through Tricare's home delivery program.

The new requirement is similar to a program introduced last February for
military retirees and family members on Tricare For Life, requiring them to fill
all their long-term prescriptions by mail or at an MTF.

The regulation would not apply to prescriptions for acute illnesses or for
generic brands. Beneficiaries still will be able to buy those at Tricare network
retail pharmacies.

DoD pays roughly 17 percent less for maintenance medications filled by mail
compared with those filled at retail stores. Savings in fiscal 2014 from DoD
efforts to move retail prescriptions to mail or military treatment facilities,
was $74.8 million, according to Pentagon data.

The new defense bill does not include any information on estimated cost savings
as a result of the program's expansion to all Tricare beneficiaries.

When asked about how Tricare would implement the new requirement, Defense Health
Agency spokesman Kevin Dwyer said the Pentagon, as a matter of policy, does not
comment on pending legislation.

Under the provision, Tricare beneficiaries would need to begin filling
brand-name prescriptions for long-term conditions - for everything from heart
medication and cholesterol lowering drugs to painkillers, anti-depressants and
more - at a military hospital or clinic or by mail starting Oct. 1.

Since the new law also will allow Tricare to raise pharmacy co-payments by $3
(with the exception of generics by mail), the new fee structure, as of Oct. 1,
would be:

For home delivery (90-day prescriptions)

    Generic: $0

    Brand-name: $16

    Nonformulary: $46

For retail pharmacies (30-day prescriptions for acute medications only)

    Generic: $8

    Brand-name: $20

    Nonformulary: $47

While the law raises pharmacy co-payments, it does so to levels much lower than
proposed by the Pentagon in its original fiscal 2015 budget request. DoD had
asked Congress to consider doubling or, in some cases, tripling co-payments over
the next several years.

It also had proposed consolidating Tricare into a single plan with a fee
structure adjusted to where beneficiaries get their medical care. That plan,
which would have eliminated Tricare Prime, Standard and Extra, would have
required retirees to pay for care at military treatment facilities and raised
co-payments for active-duty family members who use civilian providers.

But senators and representatives hammering out the authorization bill compromise
said any further changes to Tricare should wait until after the Military
Compensation and Retirement Modernization Commission makes its recommendations
on military pay and benefits, expected in February.


SOURCE:   Military Times article at




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