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Evolution of the TRICARE Pharmacy Benefit: A Decade of Change.
J Manag Care Spec Pharm. 2019 Nov; 25(11):1195-1200.JM

Abstract

TRICARE is the military's health plan that provides coverage to 9.4 million active duty and retired uniformed services personnel and their family members. The TRICARE pharmacy benefit has undergone many changes in the last decade. These changes include assigning newly approved drugs to nonformulary status after regulatory approval, the addition of weight loss medications to the benefit, channel management point-of-service requirements for some medications, and copay increases. Several initiatives have resulted in significant cost avoidance to the Department of Defense (DoD). The purpose of this article is to discuss the changes to the TRICARE pharmacy benefit, describe the continual challenges, and estimate cost savings associated with implementation of these changes. DoD implemented its 3-tier Uniform Formulary in 2005. Since then, many changes have been enacted, including more extensive use of prior authorization, step therapy, and quantity limits; coverage of over-the-counter medications; the retail refund program; coverage of vaccines and smoking cessation agents; mandatory mail/military treatment facility requirements; rapid review and initial nonformulary status for newly approved innovator drugs; revisions to the compounded drug benefit; initial deployment of a new medical record system; coverage of weight loss medications; and the ability to exclude medications from the Uniform Formulary. Although the TRICARE pharmacy benefit has evolved significantly, the focus remains on the beneficiaries, with an overall goal of providing integrated, affordable, and high quality health services for the Military Health System. Challenges for the future include maximizing clinical effectiveness in the face of rising pharmaceutical costs and cost avoidance, while supporting the needs of TRICARE beneficiaries. DISCLOSURES: No outside funding supported this study. The authors declare no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. The information discussed here represents the views of the authors and does not necessarily reflect the views of the Defense Health Agency (DHA), the Department of Defense (DoD), or the Departments of the Army, Navy, and Air Force. The authors have nothing to disclose that presents a potential conflict of interest.

Authors+Show Affiliations

Defense Health Agency, San Antonio, Texas.Defense Health Agency, San Antonio, Texas.Defense Health Agency, San Antonio, Texas.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31663455

Citation

Lugo, Amy M., et al. "Evolution of the TRICARE Pharmacy Benefit: a Decade of Change." Journal of Managed Care & Specialty Pharmacy, vol. 25, no. 11, 2019, pp. 1195-1200.
Lugo AM, Allerman AA, Trice SK. Evolution of the TRICARE Pharmacy Benefit: A Decade of Change. J Manag Care Spec Pharm. 2019;25(11):1195-1200.
Lugo, A. M., Allerman, A. A., & Trice, S. K. (2019). Evolution of the TRICARE Pharmacy Benefit: A Decade of Change. Journal of Managed Care & Specialty Pharmacy, 25(11), 1195-1200. https://doi.org/10.18553/jmcp.2019.25.11.1195
Lugo AM, Allerman AA, Trice SK. Evolution of the TRICARE Pharmacy Benefit: a Decade of Change. J Manag Care Spec Pharm. 2019;25(11):1195-1200. PubMed PMID: 31663455.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evolution of the TRICARE Pharmacy Benefit: A Decade of Change. AU - Lugo,Amy M, AU - Allerman,Angela A, AU - Trice,Shana K, PY - 2019/10/31/entrez PY - 2019/10/31/pubmed PY - 2020/3/24/medline SP - 1195 EP - 1200 JF - Journal of managed care & specialty pharmacy JO - J Manag Care Spec Pharm VL - 25 IS - 11 N2 - TRICARE is the military's health plan that provides coverage to 9.4 million active duty and retired uniformed services personnel and their family members. The TRICARE pharmacy benefit has undergone many changes in the last decade. These changes include assigning newly approved drugs to nonformulary status after regulatory approval, the addition of weight loss medications to the benefit, channel management point-of-service requirements for some medications, and copay increases. Several initiatives have resulted in significant cost avoidance to the Department of Defense (DoD). The purpose of this article is to discuss the changes to the TRICARE pharmacy benefit, describe the continual challenges, and estimate cost savings associated with implementation of these changes. DoD implemented its 3-tier Uniform Formulary in 2005. Since then, many changes have been enacted, including more extensive use of prior authorization, step therapy, and quantity limits; coverage of over-the-counter medications; the retail refund program; coverage of vaccines and smoking cessation agents; mandatory mail/military treatment facility requirements; rapid review and initial nonformulary status for newly approved innovator drugs; revisions to the compounded drug benefit; initial deployment of a new medical record system; coverage of weight loss medications; and the ability to exclude medications from the Uniform Formulary. Although the TRICARE pharmacy benefit has evolved significantly, the focus remains on the beneficiaries, with an overall goal of providing integrated, affordable, and high quality health services for the Military Health System. Challenges for the future include maximizing clinical effectiveness in the face of rising pharmaceutical costs and cost avoidance, while supporting the needs of TRICARE beneficiaries. DISCLOSURES: No outside funding supported this study. The authors declare no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. The information discussed here represents the views of the authors and does not necessarily reflect the views of the Defense Health Agency (DHA), the Department of Defense (DoD), or the Departments of the Army, Navy, and Air Force. The authors have nothing to disclose that presents a potential conflict of interest. SN - 2376-1032 UR - https://www.unboundmedicine.com/medline/citation/31663455/Evolution_of_the_TRICARE_Pharmacy_Benefit:_A_Decade_of_Change L2 - https://dx.doi.org/10.18553/jmcp.2019.25.11.1195 DB - PRIME DP - Unbound Medicine ER -