Lawmakers are interested in learning whether establishing a "preferred" retail pharmacy network for Tricare beneficiaries to use in filling drug prescriptions — including for chronic conditions — could save the government money.
The initial draft of the House version of next year's defense authorization bill would establish a pilot program to explore that idea.
The bill would require the Defense Department to set up a pilot in at least one region of the country that would create a preferred retail pharmacy network similar to such networks in the Medicare program.
In that model, participating pharmacies purchase medications for beneficiaries at rates available to the federal government and pass along at least some of the savings to patients in the form of lower co-payments.
It's unclear whether the Tricare pilot would offer the same low-cost incentive; the House bill language speaks only of assessing whether such a network would "generate cost savings" for DoD. Prescription co-pay rates under Tricare normally are uniform for all beneficiaries.
But such a pilot would at least let Tricare beneficiaries in the test region fill prescriptions for maintenance medication locally — a convenience that will not be allowed as of Oct. 1, when beneficiaries will be required to get medicines for long-term prescriptions at a military pharmacy or through mail order.
A preferred pharmacy is a network pharmacy that offers covered drugs to patients at lower out-of-pocket costs. Nonpreferred pharmacies also may remain in the network, but beneficiaries usually pay a little more to use them.
Critics say that at least in the Medicare system, many of the lower cost "preferred pharmacies" are farther away from patients than their current stores, and experience has shown that many local pharmacies are never asked to participate as preferred retailers, even though they say they would agree to meet all required terms and conditions to be one.
"Pharmacists have seen this movie before and we know how it ends: significant disruption to patients, including those homebound or with serious health challenges," said B. Douglas Hoey, who, as CEO of the National Community Pharmacists Association, advocates for independent and small pharmacies.
Hoey's group recommended that if DoD pursues the pilot, safeguards should be established to ensure that Tricare preferred pharmacy networks allow smaller pharmacies to participate and that the preferred network comply with existing Tricare retail pharmacy standards.
In Medicare prescription plans, Walmart, Kroger and Walgreen operate the most preferred pharmacy networks.
If approved, the pilot would run from May 2016 through September 2018. The bill does not specify where the pilot would be, only that the Pentagon must establish it in an area with at least one military pharmacy and a retail pharmacy chain with at least 10 locations in the region.
The full House Armed Services Committee is set to mark up its version of the 2016 defense authorization bill on Wednesday.
Patricia Kime is a senior writer covering military and veterans health care, medicine and personnel issues.
