TRICARE Pharmacy Rules Changing for Maintenance, Brand-name Drugs
WASHINGTON, August 21, 2015 — TRICARE beneficiaries who take certain brand-name medications on a regular basis will be required to fill prescriptions at a military treatment facility or through a mail-in program beginning Oct. 1, a Defense Health Agency official said yesterday.
George Jones, DHA’s pharmacy operations division chief, said the new policy does not apply to active-duty troops, overseas beneficiaries, nursing-home residents and those with other health insurance that has a prescription-drug program. In certain circumstances, he added, some beneficiaries might be waived from the program on an individual basis.
The brand-name, regularly used, or “maintenance” medications could include those to treat chronic conditions such as blood pressure or cholesterol issues, Jones explained.
Generic medications are not affected by the new policy, he said.
Beneficiaries to Be Notified
TRICARE pharmacy beneficiaries who will be affected will receive a letter from TRICARE in early to mid-September, with instructions on make the transition from retail pharmacies to a military pharmacy or the Express Scripts mail-in program, he said.
Those with questions about medications in the brand-name maintenance category can call Express Scripts customer service at 1-877-363-1303 or look up the drug online at TRICARE’s website.
Beneficiaries can track their medication status and expected delivery date by calling or going online to Express Scripts.
The new TRICARE policy stems from the 2013 National Defense Authorization Act and is designed to save beneficiaries and taxpayers money, Jones explained.
Program Expected to Save Money
“Based on estimates, the program is expected to save beneficiaries $16.5 million in reduced copays, and projected Defense Department savings is $88 million during the first year,” he said.
That translates into a savings of about $176 per medication per year, he added.
A pilot program on the new pharmacy initiative was conducted in 2014, and it was “very successful,” he added.
“It was very well received by beneficiaries and met reductions in beneficiary-put-of-pocket costs and reduced costs to the government,” he said.
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