New Law Ups Prices of Prescription Drugs for Some DoD Beneficiaries

by U.S. Medicine

February 2, 2015

By Sandra Basu

Michelle Carr, retired military, receives her medications from James Becknell, Lyster Army Health Clinic pharmacist, at the temporary pharmacy in front of a temporary pharmacy at Fort Rucker, AL. Army photo

Michelle Carr, retired military, receives her medications from James Becknell, Lyster Army Health Clinic pharmacist, at the temporary pharmacy in front of a temporary pharmacy at Fort Rucker, AL. Army photo

WASHINGTON – A new law puts into place a $3 increase this year for all prescription copays for non-active duty DoD beneficiaries except for mail order generic drugs, while leaving the question of further increases in future years still in play.

            The legislation, the National Defense Authorization Act for 2015, authorized $577.1 billion in FY 2015 for DoD. Included in that bill was the provision that authorized the increase for most prescriptions for FY 2015. The change to the pharmacy copays do not go as far as the Obama administration had originally proposed, but advocacy groups know that more changes could be looming for copays and other benefits in the future.

“This year promises to be a difficult one for the military community. Congress will face proposals to overhaul military pay and compensation while sequestration threatens to cut billions out of the FY 2016 defense budget,” the Military Officers Association of America (MOAA) warned its beneficiaries on its website.

In 2014, DoD had asked Congress to approve TRICARE pharmaceutical copays increases through 2024 that would start at the current copay of $5 for FY 2015 for generic drugs in the retail pharmacy and would ultimately be at $14 in 2024. Brand-name medications in the retail pharmacy would increase from $17 to $26 in FY 2015 and would ultimately be at $45 in 2024.

For mail order, the administration proposed that brand-name drugs would jump from $13 to $26 in FY 2015 and would eventually be at $45 in 2024. Mail order generic drugs would remain no cost until FY 2019, when they would increase to $9 and would be at $14 by 2024.

While Congress approved the $3 dollar increase for only FY 2015, lawmakers explained that they are waiting for the Military Compensation and Retirement Modernization Commission report expected this month before making any further decisions on benefits and compensation. The highly anticipated report contains the results of a congressionally mandated commission review of the military compensation and retirement systems and makes recommendations for modernization.

            “This approach does not constitute a rejection of the DoD proposal, which was endorsed by the Joint Chiefs of Staff. Rather, consideration of further changes to copays is deferred until after the committees receive the report of the Military Compensation and Retirement Modernization Commission,” a joint explanatory accompanying the legislation explained of the $3 approved increase the NDAA.

               In addition, the statement explained that, “if sequestration-level budgets remain in effect for FY 2016 and beyond, DoD will need to make painful cuts and achieve substantial savings across its entire budget in order to avoid an unacceptable reduction in readiness of the Armed Forces of the United States.”

Pay and Benefits

               In addition to the pharmacy copay change, lawmakers also considered but rejected a proposal by DoD to replace TRICARE Prime, Standard and Extra with a consolidated TRICARE health plan. The agency had argued, among other things, that it would provide a simpler system and provide “beneficiaries with open access to providers and less complexity in their health plan.”

Beneficiary groups opposed the plan and said they would again oppose it this year. The National Military Family Association testified before Congress last year that the plan “will have a significant negative impact” on certain beneficiaries.

“The additional out-of-pocket expenses will be concentrated among those who cannot receive care at a MTF and special needs families who require extensive specialty care,” the group argued.

            Meanwhile, when it comes to sexual assault — which lawmakers and advocacy groups have said DoD needs to do more to address — lawmakers approved several changes in the legislation, including:

  • Authorizing physicians, nurse practitioners and registered nurses to be assigned as sexual assault forensic examiners (SAFE) and to require service secretaries to ensure that enough SAFEs are available;
  • Requiring service secretaries to review decisions by convening authorities to not refer charges of certain sex-related offenses for trial by court-martial if requested by chief prosecutor;
  • Requiring service secretaries to ensure that the performance appraisals of commanding officers indicate the extent to which the commanding officer has or has not established a command climate in which allegations of sexual assault are properly managed and fairly evaluated; and

Eliminating the “good soldier defense” by making the general military character of the accused not admissible to show the probability of innocence of the accused for certain sex-related offenses.

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