b'TRICARE Changes in 2020 Seek to Lower Pharmacy Spending at DoDand that mail order was 99.997% free of clinical errors, while retail pharma-cies were only 98.5% error-free.Mail order also was less expensive for beneficiaries. Generic drugs filled at a retail pharmacy cost beneficiaries $60 a year in copays. Generic drugs received through mail order were free through home delivery. Use of mail order has increased more or less regularly since it was included as an option, and just under seven million prescriptions were filled through mail in FY 2018.In2015,TRICAREalsomade changes to how newly-approved inno-vatordrugswereincludedinitsfor- Air Force Staff Sgt. Albert Vallejo, 8th Medical Support Squadron pharmacy technician, pours medication mulary. New regulations defaulted thethrough a pill-counting machine at Kunsan Air Base, South Korea, in May. The pharmacy team has a goal time of 20 minutes to fill a prescription in order to provide a better customer service experience.drugs to the nonformulary Tier 3 andAir Force photo by Tech. Sgt. Joshua Arendsgave the P&T committee 120 days to recommend whether the drug would beTRICARE began screening each clini- TRICARE to add a fourth tier to its for-placed higher in the formulary. cal ingredient in a compound drug. Bymulary. Designed to encourage the use Thatsameyear,TRICAREmadeOctober 2018, costs dropped until com- of pharmaceutical agents that provide changestoaddresstheskyrocketingpound drugs made up only 14% of totalthe best clinical effectiveness, the bill costs of compound drugs. In 2010, com- benefit costs. However, the fallout ofrequired TRICARE to begin dropping pound medications made up about $24these fraud cases is still ongoing, withagents that were shown to have little million of the $6.6 billion spent on out- criminalcasesandlawsuitsagainstclinical effectiveness, creating a tier of patient pharmacy orders. In 2014, theycompounddrugmanufacturersstillcompletely excluded drugs.made up over $500 million and were onrolling through courts in 2020. This tier also includes drugs used for track to quadruple to $2 billion in 2015.Finally, in 2015, TRICARE rolled outcosmetic purposes, drugs used to treat In April 2015, compound prescriptionsits e-prescribing, or eRx, program. Theanoncoveredcondition,homeopathic made up only 0.5% of prescriptions butrollout began in October 2014 and byand herbal preparations, multivitamins, accounted for 20% of costs. March 2015 was available at over 150weight loss products and non-covered TRICARE uncovered rampant casesdispensinglocationsacrossthemili- OTC products. While the drugs are still of fraud when it came to compoundingtary healthcare system. The goal was toavailable,beneficiariesmustpayfull drugs,specificallyintheprescribingreduce the number of transcription andout-of-pocket costs.of creams to treat pain and scar tissue.translationerrors,reducewaittimesAndwhileTRICAREmanagedto Somecompounddrugmanufacturersand allow the pharmacy to address pre- keep copayment increases steady and weretakingadvantageofaloopholescription errors before the beneficiarysmallformuchofthelast15years, in the pharmacy program that allowedarrives to pick them up. the 2017 NDAA included a provision them to bill TRICARE for each ingre- The program was an unqualified suc- that raised some by as much as 50%. dient in the cream and so were includ- cessandby2018,morethanhalfofIt also made adjustments to enrollment ing as many expensive ingredients asprescriptions filed at MTFs were donefees, deductibles and catastrophic caps. they could in their creams and billingelectronically,exceedingtheDefenseThe changes were made in the hope of TRICARE accordingly. Health Agencys original goal with thelowering pharmacy spending, which in Onestudyfoundthatsuchcom- program. DHA has now set its sights2018 made up 52% of the total cost of poundedcreamsperformednobetterhigher and is aiming for filling 75% ofmilitary healthcare.than placebos. prescriptions at MTFs electronically.Theincreaseswentintoeffectin Toplugtheloophole,inMay2015In2018,theNDAAdirectedJanuary 2020.362020 COMPENDIUM OF FEDERAL MEDICINE'