New Front Opens in TRICARE Access Fight

By: | May-21-15

The Story: Retail pharmacy access – that’s the consistent battle cry for NACDS members and patients when Congress considers the National Defense Authorization Act each year.

At issue is TRICARE – the health plan for military families and veterans – and how and where its beneficiaries access prescription drugs. NACDS consistently fights proposals that would unbalance the playing field and shift patients to mail order.

This comes up every year. How is it different this time?

There are two major issues in play this year. The “copay” issue is very familiar territory, whereas an emerging “pilot program” issue is creating new dynamics.

Regarding copays, the version of the defense authorization bill passed last week by the House of Representatives does not include copay increases that would attempt to shift patients to mail order. However, the version of the legislation currently being considered by the Senate Armed Services Committee includes such copay increases. So, the familiar copay fight remains in play, even as the effort to protect pharmacy patient care has been buoyed by success in the House.

As for the new pilot program, the House-passed legislation authorizes the Secretary of Defense to test the concept of making available to retail pharmacies the same medication acquisition cost rates enjoyed by mail order and military treatment facilities. The pilot is significant for many reasons, including that it would include brand maintenance medications, which otherwise would be available through retail pharmacies for a 30-day fill, before being available only through mail order or military treatment facilities. NACDS succeeded in advocating for fine-tuning of the pilot during the House’s consideration of the legislation, and continued focus will be brought to this concept as the legislation continues through the process.

What’s next?

Following the Senate Armed Services Committee’s consideration of the bill, the full Senate will need to take it up. Ultimately, House and Senate negotiators will need to hammer out a final piece of legislation for approval by both chambers of Congress, and for delivery to the president’s desk for his consideration.

 

 

2016-06-01T11:07:37+00:00May-21-15|Categories: Article|Tags: |