TRICARE shifts to new drug co-pay formula

  • Tom Philpott / Military Update
  • Saturday, December 9, 2000 9:00pm
  • Local News

Medicare-eligible beneficiaries won’t be the only segment of the military to see changes in mail-order and retail prescription drug plans on April 1.

Active duty families, under-65 retirees and their dependents are in line for a new co-payment plan for prescriptions filled off-base, under a Defense Department initiative to simplify the benefit and encourage greater use of generic drugs.

Military elderly will get an even better deal than they anticipated under the TRICARE Senior Pharmacy Program. Other beneficiaries will see their co-pays for off-base pharmacy options adjusted to match what seniors pay. That will mean lower costs for those able to use generic drugs. Some active duty family members will see drug costs rise modestly.

The full impact of pharmacy reforms won’t be known until sometime later when Defense officials are to unveil a "uniform formulary" of drugs that will be used throughout the military.

For now, the reforms are breaking in favor of beneficiaries. Prescription drugs for active duty members will remain free, and beneficiaries still will not be charged for drugs available through base pharmacies.

But on April 1, the Defense Department plans to adopt a new tiered co-pay arrangement for beneficiaries who can’t have their prescriptions filled on-base. Here’s how it the will work:

? All military beneficiaries using the National Mail Order Pharmacy — regardless of age, beneficiary category or TRICARE enrollment status — will pay $3 for a 90-day supply of a generic drug or $9 for a brand-name drug. Active duty family members now pay $4. So, under the new plan, they will save $1 if they buy generic by mail but will pay $5 more than they do now for a brand-name drug. Mail order is the best solution for maintenance medications.

? For short-term illness or when medicines are needed fast, beneficiaries will be able to use the TRICARE retail network. Again, the co-payment will be $3 for generic, $9 for brand medicines, but only for a 30-day supply. The mail order plan then, officials say, will deliver triple the value for patients with time to use it.

? Active duty family members who are enrolled in TRICARE Prime, the managed care network, now pay $5 per prescription filled by the retail network. Retirees and their families pay $9. Both stand to save on generic drugs under the April 1 co-payment plan, but active duty families will pay $4 more than they do now on name brands.

? Users of the TRICARE retail network who are not enrolled in Prime now have a co-pay on each prescription of 15 or 20 percent of the cost, depending on whether they are an active duty dependent or a retiree. They, too, will pay only $3 or $9 for 30 days worth of medicine.

? Any beneficiaries who must rely on a non-network pharmacy will pay $9, or 20 percent of the cost for a 30-day supply, which ever is greater. This option also has an annual deductible of $150 per person or $300 a family.

Two separate laws are behind the planned April 1 changes.

In the 2000 defense authorization act, passed last year, Congress directed the Department of Defense to streamline the pharmacy benefit through greater use of generic drugs, a simplified set of co-pays and a uniform formulary — a single, approved inventory of medicines — for use in base pharmacies, the mail-order program and the retail network.

Before officials could implement these changes, Congress this fall approved TRICARE Senior Pharmacy Program. Effective April 1, Medicare-eligible beneficiaries gain the same off-base pharmacy options available to under-65 retirees.

Medicare-eligible beneficiaries had been told that, starting April 1, 2001, they can use mail order to buy a 90-day supply of drugs for $8 or have prescriptions filled in the TRICARE retail network for a 20 percent co-payment. Instead, all National Mail Order Pharmacy users, including the elderly, will begin paying only $3 for generic drugs and $9 for brand names. The 20 percent co-payment for the retail network will, it seems, disappear for a time.

What’s the hitch?

If there is one, it could show up in that portion of the pharmacy reform law that officials won’t unveil until later — the uniform formulary. A shift to a tighter formulary would be significant because the modest co-pays, of $3 on generic or $9 on branded drugs, will not apply to "non-formulary" medicines, according to Defense Department documents.

For now, all drugs available through the National Mail Order Pharmacy and TRICARE retail are viewed as on the formulary. When that changes, and it will, prescriptions for non-formulary drugs, whether filled by mail or through the retail network, will carry a hefty co-payment, likely 20 percent of the drugs’ cost.

Moving to a Uniform Formulary is expected to reduce the number of medicines available by mail order and TRICARE retail, but expand the selection on-base. Officials have concluded that base pharmacies are the most efficient way to deliver the benefit, even though no co-pay is collected.

Medicare-eligible beneficiaries will be mailed information packets on the TRICARE Senior Pharmacy Program too, but only if their addresses are up to date in DEERS, the Defense Enrollment Eligibility Reporting System.

Talk to us

> Give us your news tips.

> Send us a letter to the editor.

> More Herald contact information.

More in Local News

Kim Skarda points at her home on a map on Thursday, June 20, 2024 in Concrete, Washington. A community called Sauk River Estates has a very steep slope above it. There is a DNR-approved timber sale that boarders the estate properties, yet they were not consulted about the sale before approval. The community has already appealed the sale and has hired their own geologist to conduct a slope stability report at the site. (Annie Barker / The Herald)
Beneath steep slope, Concrete neighbors fear landslides from logging above

Nielsen Brothers plans to cut 54 acres of timber directly behind the community of 83 homes. Locals said they were never consulted.

Law enforcement respond to a person hit by a train near the Port of Everett Mount Baker Terminal on Thursday, June 27, 2024 in Mukilteo, Washington. (Annie Barker / The Herald)
2 killed in waterfront train crashes were near Mukilteo ‘quiet zone’

In June, two people were hit by trains on separate days near Mukilteo Boulevard. “These situations are incredibly tragic,” Everett’s mayor said.

Rob Plotnikoff takes a measurement as a part of the county's State of Our Waters survey at Tambark Creek in Bothell, Washington on Monday, July 1, 2024. (Annie Barker / The Herald)
Snohomish County stream team bushwhacks a path to healthier waterways

This summer, the crew of three will survey 40 sites for the State of Our Waters program. It’s science in locals’ backyards.

Logo for news use featuring the municipality of Mountlake Terrace in Snohomish County, Washington. 220118
4th suspect arrested after Mountlake Terrace home robbery

Police arrested Taievion Rogers, 19, on Tuesday. Prosecutors charged his three alleged accomplices in April.

A 10 acre parcel off of Highway 99, between 240th and 242nd Street Southwest that the city of Edmonds is currently in the process of acquiring on Monday, July 10, 2023 in Edmonds, Washington. (Olivia Vanni / The Herald)
Edmonds ditches $37M Landmark public park project off Highway 99

The previous mayor envisioned parks and more in south Edmonds, in a historically neglected area. The new administration is battling budget woes.

Edmonds school official sworn in as Mount Vernon supe

Victor Vergara took his oath of office last week. He was assistant superintendent of equity and student success in Edmonds.

The National Weather Service issued a red flag warning for the Cascade Range and Olympic Mountains on Wednesday. (Provided by the National Weather Service)
Red flag warning issued for eastern Snohomish County through Wednesday

The National Weather Service says critical fire conditions are either imminent or occurring now.

Traffic camera shows Everett and Marysville firefighters on the scene of a crane accident along northbound I-5 near milepost 198 Tuesday evening. (Provided photo)
Two workers fall from I-5 bridge Tuesday evening

The workers were in a “cherry picker” type bucket when it tipped over. One man fell 60 feet into the water and was taken to the hospital.

Everett motorcyclist dies on Highway 99

Alexis Hernandez Cerritos was riding south on Highway 99 when a car driving north turned in front of him.

Cash is used for a purchase at Molly Moon's Ice Cream in Edmonds, Washington on Wednesday, Aug. 30, 2023. (Annie Barker / The Herald)
Everett’s rival minimum wage proposals: Second group submits signatures

Supporters from Raise the Wage Responsibly said their proposal strikes a balance between employees and employers.

Components of downtown Marysville’s new stormwater treatment facility can be seen from the walkway on Thursday, July 11, 2024, in Marysville, Washington. While much of the treatment and filtering happens out of sight, visitors of the area will see troughs, left, spilling water out onto the surrounding landscape, which soaks up the filtered water before it makes its way into a nearby lagoon. Overflow grates, right, help alleviate flooding during heavy rains. (Ryan Berry / The Herald)
At new Marysville water treatment facility, plants filter out pollutants

City officials expect the $14 million project to clean 110 million gallons of water every year, reducing harm to wildlife.

Everett man sentenced to jail for threatening to bomb car dealership

The sentencing of Michael Harsh comes over two years after he threatened to bomb an Evergreen girls basketball game.

Support local journalism

If you value local news, make a gift now to support the trusted journalism you get in The Daily Herald. Donations processed in this system are not tax deductible.