![]() ![]() The DHA was created by Congress in October 2014 as a joint, integrated combat support agency designed to standardize the Army, Navy, and Air Force medical services. The purpose of this article is to review changes to the TRICARE pharmacy benefit over the last decade, describe emerging challenges, and estimate cost savings associated with these changes. ![]() No copays are collected at MTFs for any beneficiary or at any POS for active duty service members. As of February 2018, copays were $7, $24, and $53 for a 90-day supply at the mail order pharmacy for tier 1, 2, and 3, respectively, and $11, $28, and $53 for a 30-day supply at retail pharmacies. DoD pharmacy copays are set by Congress and are generally low compared with civilian counterparts. In the last decade, several notable changes have occurred, including establishment of the Defense Health Agency (DHA), the addition of weight loss medications as a benefit, an expanded mail order or MTF POS requirement for nonformulary medications, as well as some chronic disease medications, and copay increases that are commensurate to commercial plans. TRICARE has an annual $7.4 billion pharmacy spend. 2 Note that the DoD pharmacy benefit is distinct from that of the Veterans Health Administration. Beneficiaries may receive their medications at 3 points of service (POS): (1) at nearly 700 military treatment facilities (MTF) located worldwide, (2) at 1 mail order pharmacy, or (3) at 1 of approximately 56,000 retail network pharmacies. The Department of Defense (DoD) has a 3-tier formulary (generic, formulary, and nonformulary). 1 As of September 2018, the TRICARE health plan covered 9.4 million beneficiaries, including approximately 1.5 million active duty service members and their 2 million family members, along with 5.9 million retirees and families. Much has changed since the benefit was first described by Trice et al. The TRICARE pharmacy benefit is continually evolving. The authors have nothing to disclose that presents a potential conflict of interest. The information discussed here represents the views of the authors and does not necessarily reflect the views of the Defense Health Agency (DHA), the Department of Defense (DoD), or the Departments of the Army, Navy, and Air Force. The authors declare no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. Challenges for the future include maximizing clinical effectiveness in the face of rising pharmaceutical costs and cost avoidance, while supporting the needs of TRICARE beneficiaries.ĭISCLOSURES: No outside funding supported this study. Since then, many changes have been enacted, including more extensive use of prior authorization, step therapy, and quantity limits coverage of over-the-counter medications the retail refund program coverage of vaccines and smoking cessation agents mandatory mail/military treatment facility requirements rapid review and initial nonformulary status for newly approved innovator drugs revisions to the compounded drug benefit initial deployment of a new medical record system coverage of weight loss medications and the ability to exclude medications from the Uniform Formulary.Īlthough the TRICARE pharmacy benefit has evolved significantly, the focus remains on the beneficiaries, with an overall goal of providing integrated, affordable, and high quality health services for the Military Health System. The purpose of this article is to discuss the changes to the TRICARE pharmacy benefit, describe the continual challenges, and estimate cost savings associated with implementation of these changes.ĭoD implemented its 3-tier Uniform Formulary in 2005. Several initiatives have resulted in significant cost avoidance to the Department of Defense (DoD). These changes include assigning newly approved drugs to nonformulary status after regulatory approval, the addition of weight loss medications to the benefit, channel management point-of-service requirements for some medications, and copay increases. The TRICARE pharmacy benefit has undergone many changes in the last decade. TRICARE is the military’s health plan that provides coverage to 9.4 million active duty and retired uniformed services personnel and their family members. ![]()
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