b'TRICARE Changes in 2020 Seek to Lower Pharmacy Spending at DoDPrograms Pharmacy Benefit Has Evolved Over Two DecadesBy Stephen SpotswoodThe National Defense Authorization Act for fiscal year 2000the time, each facility operated under included a directive for the secretary of defense to establishits own formulary, and it was felt that a uniform formulary would not only cut an integrated pharmacy benefit. Since that time, the pharmacycosts but also provide centralized guid-benefit from TRICARE, the militarys healthcare program, hasance on medications that would have a positive impact on the health of patients changed significantly, creating new options, strengthening theacross the system.Thepharmacybenefitsprogram safety of the drugs it prescribes and having a direct impactshallincludeauniformformularyof on how patients manage their healthcare. Now, changes inpharmaceutical agents in the complete range of therapeutic classes, the legis-copayments, enrollment fees, deductibles and catastrophiclation stated. The selection for inclu-caps have been put into place this year in hopes of loweringsion on the uniform formularyshall bebasedontherelativeclinicaland pharmacy spending, which made up more than half the cost ofcost effectiveness of the agents.The provision in the bill also included military healthcare in 2018. a directive to the secretary to establish thefirstpharmacyandtherapeutics committee to help decide what would be included on the formulary. Ninety WASHINGTONTRICAREnoweligiblebeneficiariesapopulationdaysaftertheestablishmentofthe serves 9.4 million beneficiaries, spend- that included active duty servicemem- committee,thecommitteemembers ing more than $7 billion annually onbers and their families, retired militarywould have their first meeting and be prescriptionmedicationsthroughitsand family, as well as surviving familytaskedwithbeginningtheprocessof pharmacy benefit. For the past 15 yearsofdeceasedmilitarypersonnel.Thatdeciding what would be included in the the benefit has helped lower costs andyear, DoD spent a little over $2 billionTRICARE uniformed formulary.standardizeformulariesatmilitaryonpharmacybenefits,anumberthatDoDrecognizedthattheTRICARE treatment facilities nationwide. had been increasing an average of 17%system was bifurcated in terms of who Overthattime,italsohaschangedeach year for the prior six years. was doing the prescribing and that its significantly,creatingnewbenefits,With DoD and Congress looking tonewformularydesignwouldneedto strengthening the safety of the drugs itslow down the rising cost of prescrip- take that into account. There were the prescribes, and having a direct impact ontionsforitsMHSbeneficiaries,theproviders at military health facilities and how those covered by TRICARE inter- National Defense Authorization Act fortheprovidersatnonmilitaryfacilities act with the system and their healthcare. FY 2000 included a directive to the sec- that TRICARE purchased care from.In2001,themilitaryhealthsystemretary of defense to establish an inte- Tobetterunderstandtheprescrib-(MHS) had approximately 8.7 milliongrated pharmacy benefits program. Ating practices of both of these groups, 34 2020 COMPENDIUM OF FEDERAL MEDICINE'