- Introduction: A Top-Level Look at the Future of Federal Medicine
- Military Health System in Time of Transition as Conflicts End
- Army Medicine: Redefining Its Role in the Generation of a Ready and Resilient Force
- Air Force Medicine: Averting an Identity Crisis
- Moving Forward with Reforming the Indian Health Service
- The Clinical Pharmacy Specialist's Growing Provider Role in VA
- Public Health Service Pharmacy: Accelerating Transformation
- Military Pain Management’s Future: Less Invasive, More Data-Driven Techniques
- Navy Medicine: Strong, Agile and Ready
- Telemental Health in VA: A New Source of Support for Veterans
Managing Pharmacy Benefit to Achieve the Quadruple Aim
Rear Adm Thomas J McGinnis, RPh
USPHS Chief, Pharmaceutical Operations Directorate, TRICARE
In the past 16 months, TRICARE has significantly expanded and enhanced pharmacy operations in support of more than 9.6 million active duty and retired servicemembers and their families around the world. From 2009 to 2010, TRICARE obtained lower prices on retail prescription drugs, consolidated TRICARE Pharmacy program contracts, and began to provide select over-the-counter medications without co-pays. TRICARE also covered select vaccines with no out-of-pocket expense at 47,000 retail pharmacies.
Landmark changes and expansions in our nation’s healthcare also occurred in 2010. While most of the TRICARE benefit remains unaffected by the Patient Protection and Affordable Care Act, Congress is expected to address the expansion of our beneficiary population by opening our eligibility to dependant children under age 26. Also, in September 2010, TRICARE began allowing qualified retired members of the National Guard and Reserve under age 60 to purchase healthcare coverage for themselves and their eligible family members.
Each year we strive to provide better healthcare for servicemembers, retirees, and their families. The Military Health System (MHS) has adopted the Quadruple Aim model of care to attain our main goal of readiness, achieved by using cost-effective methods, supporting a healthy population, and providing positive healthcare experiences for our beneficiary population. Pharmacy operations play a significant role in attaining and maintaining readiness.
Patient safety is at the core of DoD’s Pharmacy Data Transaction Service (PDTS) and Prescription Medication Analysis and Reporting Tool (PMART). PDTS contains prescription data from all MTFs, TRICARE Pharmacy Home Delivery, and more than 60,000 retail network pharmacies. PMART rapidly and accurately assesses the medication needs of deploying servicemembers, and flags patients who are on medications that may be unsuitable for the deployed environment. Additionally it flags servicemembers’ profiles whose medications may call for a more intensive medical review.
With the continuing growth of our beneficiary population, we remain focused on providing optimal care while carefully managing our budget. TRICARE’s pharmacy program dispenses close to 2.7 million prescriptions each week and operated under a $7.5 billion budget in 2010.
The overall $50 billion Department of Defense (DoD) health budget has become an issue of concern, as healthcare costs have greatly increased since 2001. The responsible management of our budget, in line with Secretary of Defense Robert Gates’ initiatives to decrease overhead and spending within DoD, is a high priority. As we seek initiatives to control TRICARE costs in the future, the TRICARE Pharmaceutical Operations Directorate continues to work on maximizing our own efficiencies and encouraging beneficiaries to make responsible choices when receiving their prescriptions, while also focusing on increased adherence, patient safety, and disease management.
Increase Medication Adherence with TRICARE Pharmacy Home Delivery
Using a mail-order pharmacy program for maintenance medications has been shown to increase a patient’s adherence to their prescribed medication therapy, ultimately leading to better health.
TRICARE beneficiaries have three choices when filling prescriptions. They can choose to use military treatment facility (MTF) pharmacies; TRICARE Pharmacy Home Delivery (a mail-order program), or retail pharmacies. Each option has different costs to beneficiaries and to DoD. Beneficiaries have been incentivized to choose the location with the lowest price point for themselves and DoD. Prescriptions at MTF pharmacies cost the least to DoD and are provided at no cost to beneficiaries. However, since MTF locations are limited, TRICARE Pharmacy Home Delivery is the preferred alternative, especially for our beneficiary population’s maintenance medication needs.
The TRICARE Pharmacy Home Delivery is significantly under-utilized, despite its convenience and low cost to beneficiaries. Retail pharmacies, the most expensive option for beneficiaries and DoD, are the most popular point of service.
Increasing the use of TRICARE Pharmacy Home Delivery, especially for maintenance medications, is a priority. Decreasing use of retail pharmacy by beneficiaries will provide an opportunity for DoD to save at least 43% of the cost for each brand name maintenance medication prescription switched from retail to mail order. Beneficiaries can also save up to 66% of their prescription costs when they switch from a retail pharmacy to TRICARE Pharmacy Home Delivery.
In 2011, we will implement a number of strategies to reach out to beneficiaries. We want to inform them that their pharmacy choices are in their hands, but that those choices play a role in sustaining healthcare benefits for the future. Our strategies will also stress that the mail-order pharmacy program is not only a perfectly safe and reliable method for receiving maintenance medications, it’s convenient to use and can improve health by increasing adherence.
To enhance the appeal of TRICARE Pharmacy Home Delivery, we have made it easier for beneficiaries to enroll and receive refills automatically. TRICARE pharmacy users can make responsible, cost-effective, and convenient choices for themselves and for DoD; and these choices will have an effect on the available healthcare resources for their fellow servicemembers, retirees, and families.
Enhanced Patient Safety Through E-Prescribing
The TRICARE Pharmaceutical Operations Directorate is working to enable electronic-prescribing to civilian providers, including the drug’s uniform formulary status, the patient’s eligibility, and medication history. E-prescribing will utilize DoD’s Pharmacy Data Transaction Service (PDTS), which contains prescription data from all MTFs, TRICARE Pharmacy Home Delivery, and more than 60,000 retail network pharmacies.
Pharmacy patient safety will be enhanced by broadening categories of healthcare providers who can electronically prescribe to military treatment facilities, ensuring that beneficiary prescriptions from civilian healthcare providers are accurate and free of errors. TRICARE’s e-prescribing efforts will also drive more beneficiaries to MTFs and the mail-order pharmacy for their immediate pharmacy needs, even if they seek care from civilian healthcare providers.
E-prescribing maximizes the use of available technology to save TRICARE beneficiaries time and money while also providing significant savings to DoD.
The TRICARE Pharmaceutical Operations Directorate is currently working to leverage PDTS to connect with commercial e-prescribing intermediaries to allow civilian providers to electronically transmit prescriptions to MTF pharmacies, and to the mail-order pharmacy and to retail pharmacies.
Disease Management During Deployment
Utilizing existing technology and cost-savings provided by TRICARE Pharmacy Home Delivery, we will continue to support deployed servicemembers’ pharmaceutical disease management needs in 2011.
As previously mentioned, the Prescription Medication Analysis and Reporting Tool (PMART) is used by all of the armed services and has become invaluable to the medical officers assigned to combat units in preventing deployed troops from experiencing problems related to prescription medications. By identifying individual prescription needs before deployment, troops can deploy with a six month supply of medication and receive refills through TRICARE Pharmacy Home Delivery. Forward clinics do not have to stock large quantities of drugs besides those required to treat acute needs, which saves DoD a significant amount in supply costs. This efficient practice supports readiness, safety for our deployed troops, and responsible budgeting.
To further facilitate the ease and cost-savings provided by the mail-order program, the Army will be releasing an automated prescription tool through their readiness system (MEDPROS). Healthcare providers will be able to use it when writing prescriptions for deploying soldiers utilizing TRICARE Pharmacy Home Delivery for refills. This tool replaces wasteful paper prescriptions and registration forms, and auto-populates the drug and soldier’s information from a secure database. The automated prescription tool will soon be available at all Army soldier readiness sites.
The TRICARE Pharmaceutical Operations Directorate is committed to facing the challenges of meeting our goals in the coming year. We look forward to enhancing readiness and improving the health and healthcare experiences of the growing TRICARE beneficiary population. We will continue to make it easy for beneficiaries to adhere to their prescribed therapies by employing the latest technologies and cost-effective measures in an effort, along with our beneficiaries, to continue to manage pharmacy costs responsibly.