View Full Version : Regarding Prescriptions

04-11-04, 06:38 AM
TRICARE Management Activity (TMA) announces the publication of the Uniform Formulary's final rule on April 1, 2004, in accordance with the requirement established in the fiscal year 2000 National Defense Authorization Act, Section 701, "Pharmacy Benefits Program." The final rule, effective May 3, 2004, establishes the process for determining the formulary status for prescription drugs into one of three cost-share tiers, based upon their relative clinical and cost effectiveness.

"The Uniform Formulary will bring consistency and standardized formulary management to our $4 billion pharmacy benefit," said Dr. William Winkenwerder, Jr., assistant secretary of defense for health affairs. "The new tiered cost-share structure encourages a more cost-effective use of the benefit while also providing beneficiaries with continued access to the medications they need."

Once the new structure is fully implemented, prescription drugs on the current Military Health System (MHS) formulary will be categorized as generic, formulary (brand-name), or non-formulary. Prescription drugs will be evaluated based on their relative clinical and cost effectiveness when compared with other drugs in the same therapeutic class. The process will be guided by the Department of Defense (DoD) Pharmacy and Therapeutics Committee, comprised of physicians and pharmacists. This committee will receive input from a Beneficiary Advisory Panel representing the general interests of all DoD beneficiaries. The Uniform Formulary final rule does not change the TRICARE prescription drug benefit. The benefit includes the U.S. Food and Drug Administration approved drugs and medicines that by U.S. law require a physician's or other authorized provider's prescription. It does not include prescription drugs which are used in medical treatments or procedures which are expressly excluded from the TRICARE benefit by statute or regulation. The list of prescription drugs which are categorized as non-formulary will be published when the final determinations are made.

"The military treatment facility (MTF) remains the best value for all users of the TRICARE pharmacy program," said Col. William Davies, director, DoD Pharmacy Programs. "By having prescriptions filled at the MTF, TRICARE beneficiaries eliminate their out-of-pocket costs."

In the future, prescriptions filled by the TRICARE Mail Order Pharmacy will cost $3 for up to a 90-day supply of a generic medication, $9 for up to a 90-day supply of a brand-name formulary medication, and $22 for up to a 90-day supply of a non-formulary medication. Prescriptions filled using a retail network pharmacy will cost $3 for up to a 30-day supply of a generic medication, $9 for a 30-day supply of a brand-name formulary medication, and $22 for up to a 30-day supply of a non-formulary medication.

Beneficiaries choosing to fill prescriptions using a non-network pharmacy will pay either $9 or 20 percent of the total cost of the prescription, whichever amount is greater, for both generic and brand-name formulary medications; and $22 or 20 percent, whichever amount is greater, for up to a 30-day supply of non-formulary medications. Applicable deductibles for non-network pharmacy use must first be met.

Up-to-date information on the TRICARE Pharmacy Program will be available on the TRICARE Web site at www.tricare.osd.mil/pharmacy. TMA will announce the implementation schedule as the information becomes available.