b'TRICAREhiredtheRandCorp.to study how each group interacted with formularies. Using a series of surveys, Rand polled MHS providers to discover notonlyhowtheyprescribeddrugs but how they felt about formularies in general.The surveys found that purchased care providers were very formulary-literate, havingkepttrackofformulariesfor multipleinsuranceproviders,butdid not consider formulary management to greatly impact quality of care. Direct-careprovidersatmilitarytreatment facilitiesfeltverydifferently.While they were usually only familiar with theAir Force Maj. Alexander Brown, 8th Medical Support Squadron chief of pharmacy, reviews a medication label at formularies at their own facility, theyKunsan Air Base, South Korea, in May. The pharmacy team provides multiple screening processes of medication consideredformularymanagementtoand medical history to ensure patient safety. Air Force photo by Tech. Sgt. Joshua Arendshave a direct impact on quality of care and believed controlling costs through85 drugs in Tier 3. The panel providesprogram the following year to include management was important. transparency to what in other systemsall CDC-recommended vaccines.Recognizingthatcommunicatingcan be a mystifying process, while giv- 2015wasahallmarkyearfor formularychangestopurchased-careing beneficiaries a voice in what medi- TRICAREspharmacy,withanum-providers would be challenging at best,cations are included into the formulary. ber of high-impact changes going into TRICARE established a three-tier for- Since its creation, the formulary haseffect. That year, TRICARE announced mulary:brandnamedrugs,genericshiftedandgrownconsiderably.Inthat moving forward all branded medi-drugsandnonformularydrugs.The2008, TRICARE implemented a pilotcationsforchronicdiseasescom-third tier included drugs not included inprogramthatincludedcoverageofmonlycalledmaintenancemedica-the formulary but were FDA approvedselectover-the-countermedicationstionswould need to be filled at a mili-and were available for a higher copay. with a doctors prescription. After yearstary treatment facility or through mail of extending the pilot, it was made aorder. This was done to push beneficia-T hree - TierF ormulary permanentbenefitin2016.In2010,ries toward mail order, if possible. An Thethree-tierTRICAREUniformthe formulary began making vaccinesinspector general report had found that Formulary went live in 2005. Also es- availablethroughitsretailpharmacythe mail order program cost 16.7% less tablished in 2005 was the Uniformednetwork at a $0 copay, expanding thethanprescribingatretailpharmacies Formulary Beneficiary Advisory Panel, or BAP. Comprised of nongovernmen-talorganizationsthatrepresentben-eficiaries,pharmacycontractorsandRecognizing that communicating formulary TRICARE network providers, the pan-el meets regularly to publicly discusschanges to purchased-care providers would be recommendationsmadebytheP&Tchallenging at best, TRICARE established acommittee.Initsfirstthreeyears,thepanelthree-tier formulary: brand name drugs, generic held 12 quarterly meetings to discuss 343 medications spread over 32 drugdrugs and nonformulary drugs.classes, resulting in the addition of 166 drugs in Tier 1, 92 drugs in Tier 2 and 2020 COMPENDIUM OF FEDERAL MEDICINE 35'