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 nongeneric 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.
Patricia Kime is a senior writer covering military and veterans health care, medicine and personnel issues.
