Starting Oct. 1, Tricare beneficiaries with long-term prescriptions for brand-name medications to treat chronic conditions will need to fill them by mail or through a military pharmacy.
Under an interim rule published by the Defense Department on Aug. 6, Tricare will begin requiring these beneficiaries to use the Tricare Mail Order Pharmacy System or pick up their prescriptions at a military hospital or clinic.
"Maintenance medications" means all prescriptions for chronic health issues, from high blood pressure medicine and cholesterol-lowering drugs to painkillers, antidepressants and more.
The new rule will not apply to prescriptions for generic drugs, for drugs prescribed to treat acute illnesses and for prescriptions covered by other medical insurance, according to the interim regulation.
Congress mandated the change in the fiscal 2015 National Defense Authorization Act, signed into law Dec. 19. It is similar to a pilot program introduced in February 2014 that requires Tricare For Life beneficiaries to fill all long-term prescriptions by mail or at a military facilities.
Defense officials say 61 million prescriptions were filled under Tricare at retail pharmacies in fiscal 2014, at a cost to the government of $5.1 billion.
The new rule is expected to save money, since the government pays 32 percent less for brand-name maintenance medications filled by mail or through military pharmacies than at retail stores. Defense officials estimate the program could save at least $88 million a year.
DoD savings over the first year of the Tricare For Life pilot program totaled $123 million.
Defense officials stress that the new requirement not only will save the government money, it will also help beneficiaries. DoD estimates that beneficiaries may save an average of $176 per prescription a year by moving their brand-name prescriptions from retail to home delivery or a military treatment facility, since co-payments are lower and most prescriptions available through mail are filled for 90 days.
Under the interim rule, the Defense Health Agency will maintain a list of the medications it considers maintenance drugs and will publish the list on the Tricare Pharmacy Program website and make it available through the Tricare Pharmacy Program Service Center telephone system.
Under the new program, patients can fill new prescriptions for maintenance medications at a military treatment facility or receive a 30-day or less supply from a retail pharmacy. They will then be required to refill the prescription at the MTF or by mail.
Tricare will grant case-by-case waivers for personal hardship, emergency or "other special circumstance," according to the rule. Waiver requests will have to be made through Express Scripts, Tricare's pharmacy benefits management company.
Currently, Tricare beneficiaries can fill a 90-day prescription for a generic medication at no cost by mail or pay $8 for a 30-day supply at a retail pharmacy. They must pay $16 for a 90-day prescription for brand names by mail and $20 for a 30-day brand-name prescription at retail pharmacies.
Medications not listed in Tricare's formulary run $47 for a 30-day prescription at a retail pharmacy and $46 for a 90-day prescription by mail.
Prescriptions filled at military pharmacies are available to beneficiaries at no cost.
Tricare pharmacy co-payments have become a source of contention this year during deliberations on the fiscal 2015 defense authorization bill, with Senate negotiators wanting to increase fees for brand-name prescriptions and drugs not listed in the Tricare formulary.
House lawmakers negotiating the final version of the bill remain opposed to the increases.
The two bodies are expected to negotiate an agreement and finalize the broader bill after they return to Washington, D.C., from their summer recess Sept. 8.
Patricia Kime is a senior writer covering military and veterans health care, medicine and personnel issues.
