4 Changes to Military Health Care Coverage


The recently passed 2016 National Defense Authorization Act includes a few key changes that will affect military and veteran health care coverage.

The recently passed 2016 National Defense Authorization Act (NDAA) includes a few key changes that will affect military and veteran health care coverage.

The 2016 NDAA hit several roadblocks on the road to the Oval Office, many of which were related to disputes over changes for Tricare beneficiaries administered by the Department of Veterans Affairs (VA). Nevertheless, President Barack Obama signed the 2016 NDAA into law the day before Thanksgiving.

Here are some of the new changes that pharmacists should pass along to Tricare-covered military families and veterans:

1. Increased Prescription Co-Pays

Tricare beneficiaries who opt to fill their prescriptions at retail pharmacies or choose to receive brand-name drugs through a mail-order pharmacy will see their co-pays increase.

The co-pay for 30-day prescriptions filled at a non-military pharmacy will increase by $2, to $10 per refill, while brand-name drug co-pays will rise to $24, up from $20.

Meanwhile, 90-day prescription mail-order brand-name drug co-pays will rise from $16 to $20, and the co-pays for any drugs not included on Tricare’s formulary will increase from $46 to $49.

Under a federal rule codified in September, generic medications filled by mail-order pharmacies and prescriptions filled at VA pharmacies will continue to come at no out-of-pocket cost.

The co-pay hike in the 2016 NDAA marks the third instance where medication co-pays have increased for military families and retirees in the last 4 years, including a $3 increase that took effect earlier this year.

2. Medication Continuity for Certain Disorders

Under the 2016 NDAA, both Department of Defense (DoD) and VA department pharmacies will be mandated to stock the same medications to treat pain, sleep, and psychiatric disorders beginning June 1.

In the past, differences between the departments’ formularies created issues for patients who were unable to access the same formulation of their prescriptions when they switched from active duty to VA care. The new synchronization will ensure that patients leaving active duty have continuity of medications during this transition.

Medication continuity is especially important for US veterans with post-traumatic stress disorder (PTSD), given that studies have suggested veterans with PTSD face greater odds of developing heart failure than those who do not.

According to the VA, between 11% and 20% veterans who served in Operations Iraqi Freedom and Enduring Freedom have PTSD, compared with the 7% to 8% of Americans who never served.

3. Pilot Programs for Value-Based Care Incentives

The 2016 NDAA tasks the DoD with developing a “value-based incentives” pilot program that gives payment incentives to health care professionals who provide care to veterans. This will help shift providers’ focus from volume to patient outcomes and other quality metrics.

The intention of this initiative, as worded in the law, is to “improve the quality of health provided to covered beneficiaries under Tricare” and “the experience of covered beneficiaries in receiving care under Tricare.”

The 2016 NDAA also includes a provision that requires the DoD to develop a pilot program that would allow Tricare beneficiaries to visit an urgent care clinic up to 4 times per year without a referral from their primary care provider.

4. Increased Access to Quality Mental Health Care

The list of mental health counselors qualifying for reimbursement under the Tricare program will be expanded under the 2016 NDAA to include counselors who have master’s degrees or hold PhDs—regardless of whether they are affiliated with the DoD.

“The Secretary of Defense shall develop a system by which any non-Department mental health care provider that meets eligibility criteria…receives a mental health provider readiness designation from the Department of Defense,” the text of the law reads.

The DoD will also create a system to compile and analyze data regarding mental health services and treatment at military medical facilities. This initiative is intended to evaluate the degree to which providers have the expertise needed to treat the unique needs of this patient population.

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