Tricare users can get a waiver to avoid a price hike at retail pharmacies on some name-brand medications if the drugs are back-ordered by the mail-order pharmacy, officials said.
Those who must purchase some name-brand medication by mail order, pick them up from a military treatment facility or pay for them out of pocket starting Oct. 1 would be eligible for the waiver.
The new fee plan for prescription drug refills considered "maintenance" medications removes the current subsidy for buying those drugs at a retail pharmacy.
If a beneficiary does not live near a military treatment facility, where drugs can be picked up for free, he or she must pay $16 for a 90-day supply of the medication delivered by mail through Express Scripts, the pharmacy benefits company hired by the Defense Department to perform the work.
Currently users also have the option to pay $20 for a 30-day supply at an in-network retail pharmacy. That option, however, will end Sept. 30. Refills purchased at retail pharmacies thereafter without a waiver will come entirely out of the buyer's pockets.
Rather than force users to pay the full price out of pocket if the drug is on backorder by mail, officials said, Express Scripts can grant users an immediate override to allow the medication to be purchased at a retail pharmacy under the current price scheme. The override will be good for 30 days, they said.
However, Express Scripts often experiences shortages of both name-brand and generic medications, some users have complained to Military.com.
And while Defense Department officials say shortages are experienced by all retail pharmacies, not just Express Scripts, they said they may be worse for Express Scripts due to purchasing rules they must follow when buying drugs for resale, according to a letter sent Sen. Bill Nelson, a Democrat from Florida, from Tricare's pharmacy chief and obtained by Military.com.
"The Department of Defense is required to purchase medications for dispensing at the Mail Order Pharmacy that meet federal requirements mandated by the U.S. Food and Drug Administration and are compliant with the Trade Agreements Act of 1979," states the letter, which was signed by Tricare's pharmacy chief George Jones.
"Retail pharmacies are not required to comply with the Trade Agreements Act; thus they might have supplies of medications when the Mail Order Pharmacy does not," it states.
Sixty-six drugs, including generic and name-brand medications, are currently experiencing a shortage, according to the Food and Drug Administration.
Officials with the Military Officers Association of America, an advocacy group in Alexandrian, Virginia, said they are concerned an influx of new mail-order users may result in even more Express Scripts shortages. They said while they believe Express Scripts can overcome the problems, they plan to keep a close watch on the situation, said Kathy Beasley, a deputy director of government relations for the organization.
--Amy Bushatz can be reached at email@example.com.