House-Senate conferees have agreed to the more modest House-passed plan for raising drug co-payments on military family members and retirees who fill prescriptions at TRICARE retail outlets or through mail order.
The fee increases are scheduled to take effect Feb. 1, TRICARE officials said as the fiscal 2013 defense authorization bill, with many other provisions impacting the military community next year, moved toward final passage.
The new pharmacy fee plan includes a requirement that beneficiaries 65 and older have all maintenance drugs for chronic conditions refilled, for at least one year, through TRICARE mail order or at base pharmacies, rather than through retail outlets where the cost to TRICARE is a third higher.
TRICARE likely will need to publish a draft regulation, solicit public comment and launch an education effort for elderly beneficiaries before it begins to enforce home delivery for seniors. That could delay starting that portion of the pharmacy plan until April or later.
It is a matter “under review and as yet we do not have an implementation time frame established,” said Kevin Dwyer, deputy chief of benefit information and outreach for the TRICARE Management Activity.
After January, at TRICARE retail outlets, the current $12 co-pay for brand name drugs on the military formulary will rise to $17. The $25 co-pay for non-formulary drugs will jump to $44. The co-pay for generic drugs at retail will stay at $5. Drugs will stay free at military pharmacies.
For mail order, the current $9 co-pay for brand names on formulary will increase to $13. The $25 co-pay for brand names off formulary will jump to $43. Generic drugs will continue to be dispensed by mail at no cost.
Mail order users of brand name drugs save two-thirds on co-pays automatically because refills are for 90 days versus 30 days at retail. Given those savings and the convenience of home delivery, backers of the House plan expect most elderly beneficiaries, once forced to use mail order, to stay with it, saving TRICARE hundreds of millions of dollars year after year.
The projected savings allowed the House to roll back the drug fee increases sought by the administration without raising the budget’s top line. In fact, so many TRICARE dollars will be saved that conferees used some of that money to fix a “glitch” in Combat-Related Special Compensation (CRSC).
CRSC ‘GLITCH’: Effective Jan. 1, several thousand retirees forced from service short of 20 years due to combat-related disabilities will see their compensation pop by an average of a few hundred dollars a month. These folks became eligible for CRSC in 2008 when Congress expanded the program to cover these so-called “Chapter 61” retirees. But the formula for calculating payments had a flaw, which some disabled retirees noticed when the VA raised their disability rating but their take home pay didn’t change.
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