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TRICARE Proposes Simplified Pharmacy Co-Payment Schedule

By Gerry J. Gilmore
American Forces Press Service

WASHINGTON, Dec. 12, 2000 – TRICARE officials propose to simplify co-payments for prescription drugs in accordance with last year's authorization act. The new co-payments will be uniform for all beneficiaries and based on whether a generic or brand-name medication is dispensed.

The current co-payment structure is complex and confusing, said Army Lt. Col. William G. Davies, director of DoD Pharmacy Programs, part of the TRICARE Management Activity in Falls Church, Va.

"We're trying to improve the TRICARE pharmacy benefit, to make it simpler to understand and more uniform consistent and equitable for everyone," Davies said. If the proposal is approved, he said, it would be kicked off DoD-wide April 1, 2001, when the TRICARE Senior Pharmacy program is operational.

Under the proposed changes, beneficiaries would pay $3 for generic prescription drugs and $9 for brand-name drugs at TRICARE-affiliated retail drug stores for up to a 30-day supply or through the National Mail Order Pharmacy program for up to a 90-day supply.

TRICARE Prime enrollees who choose to obtain their prescription drugs from non-TRICARE affiliated retail outlets would continue to pay a 50-percent point-of-service penalty after meeting their deductible. All others would pay the greater of a 20-percent co-pay or a $9 charge per prescription.

"There are cost savings available to the majority of the beneficiary population," Davies said, depending on how the prescription drugs are obtained. Prescriptions obtained through the mail program are generally less expensive, he noted, because the government gets federal pricing. Also, the patient can receive three times the quantity for the same co-pay as through a TRICARE retail pharmacy.

Davies noted there is no co-pay for prescriptions filled at military hospital and clinic pharmacies. This, he said, is the best financial value for beneficiaries.

Beginning April 1, 2001, military retirees age 65 and over will be provided the same pharmacy benefit offered to beneficiaries under age 65.

Davies said the TRICARE Senior Pharmacy program would replace both the Pharmacy Redesign Pilot program conducted since July at Fleming, Ky., and Okeechobee, Fla.

Persons who turn 65 before April 1, 2001, may participate in the pharmacy program without having Medicare Part B, but those who turn 65 after April 1 must be enrolled in Medicare Part B to participate, officials noted.

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