Tricare beneficiaries' access to brand-name drugs would be limited

2014-12-04T10:02:27-05:00

From: Navy Times

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.

http://www.navytimes.com/story/military/benefits/health-care/2014/12/03/tricare-home-delivery-brand-name-medications/19836273/

Response by SFC Mark Merino made Dec 19 at 2014 10:46 PM

2014-12-19T22:46:19-05:00

I'll take a pill called "no more owies" as long as it is the same as Percocet.

Response by Maj Private RallyPoint Member made Dec 20 at 2014 11:16 AM

2014-12-20T11:16:06-05:00

I have no problem with that since all of mine are filled through Express Scripts.

Added: I said I have no problem at all but I have in the past had problems with Express Scripts.

1) they started changing my blood pressure medicine and making me take another drug. It took about two months to get it back under control and that was after I contacted Express Scripts Chairman of the Board to get their attention.

2) EP wants you to use their automatic refills. I went along with that until they sent so much that I had over a year's supply of my prescription medicine so I turned it off and manage my refills.

Response by SSG Daniel Deiler made Dec 20 at 2014 12:07 PM

2014-12-20T12:07:16-05:00

How else are scripts filled other than through an MTF or mail?

Response by MAJ Robert (Bob) Petrarca made Jun 9 at 2015 7:27 PM

2015-06-09T19:27:25-04:00

Oh is it limited! They made my doctor try 2 other medications prior to approving the requested one Took over 2 months of trials, me not doing well on the Tricare "desired" meds, doctor reports as to why the first 2 meds didn't work and waiting 5-6 business days for each preauthorization approval. Oh and then there's the "separation of powers" BS. Tricare bills you but Express Scripts handles the meds. Neither company seems to want to communicate with the other. When you need information you get transferred back and forth because Tricare says its a medication issue that ONLY Express Scripts handles and Express Scripts can't answer the question because Tricare is the insurance company - DUH?? Apparently insurance companies know more about patient care than doctors do.

Response by COL Vincent Stoneking made Jun 9 at 2015 9:30 PM

2015-06-09T21:30:23-04:00

As stated in the article, I don't believe that this will have a limiting effect on patient access to name-brand drugs. If it's acute, you can still use the pharmacy. If it's long-term/maintenance, you get it via mail order (or MTF). Patient gets the same drugs, even with delivery to their doorstep, system saves about 17%. At least on the surface, this seems to make a lot of sense.