Encouraging Use of the Most Cost Effective Points of Service

TRICARE beneficiaries have three choices when filling their prescriptions: MTF pharmacies, the mail-order pharmacy program or retail pharmacies. Because each location has different costs to the beneficiaries and DoD, beneficiaries have been incentivized to choose the location with the lowest price point for themselves and DoD. Prescriptions at the MTF pharmacy cost the least to DoD and are provided at no cost to the beneficiaries. However, because MTF locations are limited, TRICARE Pharmacy Home Delivery is the preferred alternative to the MTF pharmacy and retail pharmacies, especially for our beneficiary population’s maintenance medication needs.

Retail pharmacies are the most expensive option for beneficiaries and DoD, yet they are the most frequently sought point of service. Increasing use of the Home Delivery Program, especially for maintenance medications, is a priority. In fiscal year 2010, the tangible benefit to the government from encouraging use of the Home Delivery Program was a savings of more than $31 million, following an unprecedented 10% increase in the use of the Home Delivery Program option. During the same period, the retail growth rate slowed significantly. On average, every time a TRICARE beneficiary uses the Home Delivery Program for a brand-name prescription instead of the TRICARE Retail Pharmacy option, the government saves approximately 25%, with no decrease in the quality or safety of the benefit.

In 2011, TRICARE developed and implemented an overarching communications plan to promote the use of the cost-effective Home Delivery Program. Beyond cost savings for beneficiaries and the DoD, using mail-order pharmacy for maintenance medications has been shown to increase patient adherence to their prescribed drug therapy, and, ultimately, and to lead to better health. Encouraging use of this cost-effective pharmacy venue will remain a priority for 2012.

The change to pharmacy copays on Oct. 1, 2011, was the first change to pharmacy copays since 2002. The new copay structure, with $0 copays for generics through the Home Delivery Program, will further encourage use of this less expensive point of service.

Maximizing Use of Technology

Maximizing available technology to save TRICARE beneficiaries time and money while providing significant savings for DoD is an ongoing priority. TRICARE’s e-prescribing efforts will drive more beneficiaries to MTFs and Home Delivery for their pharmacy needs, even if they seek care from civilian healthcare providers.

The TRICARE Pharmacy Operations Directorate is working toward enabling electronic prescribing, including uniform formulary status, patient eligibility and medication history from civilian providers and MTFs to all points of dispensing (MTF, mail order and retail). E-prescribing will utilize DoD’s Pharmacy Data Transaction Service (PDTS), which contains prescription data from all MTFs, the TRICARE Pharmacy Home Delivery Program and more than 64,000 retail network pharmacies for all TRICARE beneficiaries who use their pharmacy benefit.

TRICARE’s current focus is on implementing electronic prescribing from civilian providers to MTF pharmacies. Approximately 34% of all civilian providers already use e-prescribing and TRICARE seeks to ensure that MTFs, the least costly point of service, remains a viable option along with Home Delivery where e-prescribing is currently in use for beneficiaries.

Medication Adherence

Nearly three out of four Americans do not take their medications as directed, a problem known as medication nonadherence. TRICARE has joined the National Consumer League (NCL) and other partners in launching the “Script Your Future” campaign to encourage patients to take their medications as directed.

According to the NCL, one-in-three Americans never fill their prescriptions, and one-third of hospital admissions are linked to poor adherence. This is especially true for people with chronic health conditions that can worsen quickly without proper medication use. In addition, the NCL reports that up to $290 billion a year in medical costs can be attributed to poor medication adherence. 

The least-effective and most-expensive pill TRICARE provides is the one a beneficiary never takes, and following the labeled directions for prescription medications is one of the easiest ways to help protect and improve overall wellness. The new $0 copay vaccination program in 50,000 TRICARE network pharmacies is yet another way TRICARE is fostering health promotion and disease prevention for our beneficiary population.

The TRICARE Pharmacy Operations Directorate is committed to facing the challenges ahead, meeting its goals to enhance readiness, improving the health of the growing TRICARE beneficiary population, and continually striving to manage costs while ensuring outstanding pharmacy care.

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