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December 2, 2015
New TRICARE Policy Limits Prescriptions Filled at
Community Pharmacies

Washington, D.C.—If pharmacies that serve a lot of military health insurance beneficiaries are seeing a decline in business since the beginning of October, here’s a possible explanation: TRICARE beneficiaries who take brand-name maintenance medications now must fill their prescriptions at military treatment facilities (MTFs) or through a designated mail-order pharmacy.

Only generics and medications for acute illnesses can still be filled through retail pharmacies, according to the new policy.

Beneficiaries who fill brand-name prescriptions for a maintenance drug at a network retail pharmacy after October 1 will receive another notice of the change. After one more courtesy refill at that pharmacy, they will incur the full price of the medication unless they switch to the mail order program or get refills at a MTF, according to the TRICARE website.

The Department of Defense (DoD) started piloting the program last year among TRICARE for Life (Medicare-eligible) beneficiaries. That program, which ran from March 2014 through October 1, 2015, enrolled more than 200,000 beneficiaries and saved more than $130 million as of August 2015, according the DoD.

The move was strongly opposed, however, by pharmacy groups such as the National Association of Chain Drug Stores (NACDS).

In congressional testimony last year, NACDS emphasized the benefits of local pharmacies, saying it “supports cost savings initiatives that preserve patient choice, but threatening beneficiary access to prescription medications and their preferred healthcare provider will only increase the use of more costly medical interventions, such as physician and emergency room visits and hospitalizations.”

In addition, the NACDS pointed out that TRICARE beneficiaries who use mail order will miss out on medication counseling and medication therapy management (MTM) offered by pharmacies to their customers.

“Policymakers have begun to recognize the vital role that local pharmacists can play in improving medication adherence,” NACDS said in its statement.

The good news for pharmacies located near military bases is that active duty forces are exempt from the mandate.



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