- Condition Centers
Congress has begun its annual consideration of defense-authorization legislation, and both the House and Senate have included important provisions in their bills regarding the TRICARE program, the Department of Defense (DOD) health benefit that provides coverage for >9 million active-duty military, retirees, and their families. When enacted into law, the final bill will have a dramatic impact on the ability of TRICARE beneficiaries to obtain their prescription medications from the pharmacy of their choice.
In order to maintain choice for our nation's military, Congress must provide a much-needed clarification in the legislation. Currently, the DOD receives federal pricing discounts for TRICARE prescriptions dispensed by mail order and onbase pharmacies, but these same discounts are not provided for TRICARE prescriptions dispensed by retail pharmacies. The lack of discounts makes retail prescriptions disproportionately more expensive for the DOD, and therefore creates an incentive to steer beneficiaries to mail-order. As a result, some policy makers have argued that copayments and other tools should be employed to drive mail-order use, despite the fact that TRICARE beneficiaries - particularly retirees - have demonstrated a strong preference to obtain prescription medications from their local pharmacies.
Efforts to steer TRICARE beneficiaries to the mail-order program have had only modest success, and would be unnecessary if Congress leveled the playing field between mail and retail by providing this legislative clarification. In addition to allowing beneficiaries to use the pharmacy of their choice, the DOD had estimated that obtaining federal discounts for TRICARE prescriptions dispensed by retail pharmacies would help its bottom line, saving >$250 million annually.
Recognizing the importance of this issue, the House of Representatives passed its probeneficiary, probudget defense bill, and included the necessary clarification on federal discounts for retail prescriptions. In addition, the House bill also includes a provision prohibiting increases to retail-pharmacy copayments for the next fiscal year. As of press time, the Senate bill was still at the committee level. Although it also provides the federal discounts for retail prescription clarification, the bill has not yet come to the Senate floor, so changes could still be made. We remain hopeful that the Senate will join its House counterparts in passing legislation that provides the DOD with the ability to control prescription-drug costs while maintaining freedom of choice for TRICARE beneficiaries.
Community pharmacy is not sitting on the sidelines while Congress debates this important issue. The Coalition for Community Pharmacy Action has implemented an aggressive grassroots campaign, and is working closely with military beneficiary groups and others committed to protecting choice and maintaining access to retail pharmacies. Members of the House and Senate have also been invited to visit their local pharmacies. You can help by telling your TRICARE patients about this issue and encouraging them to let Congress know why choice is important in their pharmacy benefit. Together we will make sure that Congress hears our message to protect the right of our nation's military to choose their pharmacy provider.