Military retirees and family members who use Tricare For Life will be required to start filling long-term prescriptions by mail starting Feb. 14, 2014.
Under an interim rule published by the government Wednesday, retirees and family members age 65 and older must begin filling their maintenance medication prescriptions by mail when they come up for renewal on or after Valentine’s Day next year.
The requirement applies to maintenance medications only, not those needed for acute illnesses. It also will not apply to prescriptions covered by other health insurance.
The Defense Department has determined that nearly half the 70 million prescriptions filled for Tricare beneficiaries at retail pharmacies in fiscal 2012 were for Tricare For Life beneficiaries, at a cost of $2.2 billion to the government.
Since DoD pays 17 percent less for maintenance medications filled by mail compared with those filled at retail stores, Pentagon analysts concluded that costs could be trimmed significantly — by at least $120 million a year — if Tricare for Life beneficiaries were required to use mail order.
The requirement also will save beneficiaries money: a 90-day refill of a generic medication costs nothing by mail, but require a $5 copayment for a 30-day prescription at retail stores. Brand name drugs cost $13 for a 90-day prescription by mail but $17 for a 30-day prescription at a store.
Over the next month, Tricare will begin publicizing the pending change. Affected beneficiaries also will receive letters.
Beneficiaries will be able to opt out of the five-year initiative after one year. Their obligation starts when they first fill a prescription through mail order, according to the rule published in the Federal Register.
To make up for any delays between ordering refills and receiving them, the new rule will allow beneficiaries to receive up to two 30-day refills at a retail store during the transition.
Public Health Service Rear Adm. Thomas McGinnis, the Defense Health Agency’s pharmacy operations chief, said recently that Tricare and Express Scripts, Tricare’s pharmacy contractor, have established a telephone concierge service to help beneficiaries make the switch.
With a patient’s permission, Express Scripts will contact the prescribing physician to help transfer the prescription. Express Scripts also will staff its toll-free number to serve customers as well as pharmacists and physicians.
Case-by-case waivers may be granted out of personal hardship, emergency or “other special circumstance,” according to the rule. Waiver requests would have to be made through Express Scripts.
A congressional budget analysis conducted in May 2012 said the program likely would save $150 million a year, and it estimates that from 2013 to 2022, total savings from the proposal would be $1.1 billion.
A 2012 Military Officers Association of America survey of 130,000 members found that more than 92 percent of those who tried the mail-order system report being “very satisfied” or “mostly satisfied” with it.
Retired Lt. Cmdr. Steve Tennison, of Pampa, Texas, who uses Tricare Standard, said his family recently received a phone call from Express Scripts offering to switch their maintenance medications to the mail order pharmacy.
He described the process as “painless” and said his medications now arrive roughly every 60 days by mail, for free.
“We just talked to them on the phone and a few weeks later, the postman delivered a big plastic bag of medicine,” Tennison said.
Refills can be ordered by calling 1-877-363-1303 or by going online at Express Scripts.
Tricare beneficiaries, including Medicare-eligible ones on Tricare for Life, also can fill prescriptions and receive refills at no cost at military treatment facilities.