TRICARE to Cover Some Experimental Drugs for COVID-19

TRICARE to Cover Some Experimental Drugs for COVID-19
An airman at Mississippi's Keesler Medical Center prepares a COVID-19 sample for testing. (Photo by Airman 1st Class Spencer Tobler/Air Force)

Editor’s note: This article by Patricia Kime originally appeared on Military.com, a leading source of news for the military and veteran community.

  

In a deviation from its restrictions on paying for experimental medications, Tricare will partially cover investigational drugs used to treat COVID-19, the Defense Department announced.

 

According to an interim change to the military health program's manual, it will cover or cost-share, depending on the Tricare plan, experimental therapies for the novel coronavirus that receive "expanded access" status by the U.S. Food and Drug Administration.

 

The coverage applies to medications disbursed in any FDA-approved setting other than clinical trials, Tricare officials said. 

 

[LATEST NEWS AND GUIDANCE: MOAA.org/Coronavirus]

 

Since the outbreak began in the U.S., the FDA has issued at least six emergency use authorizations, or EUAs, for potential COVID-19 treatments, including permissions for the drug remdesivir, for convalescent plasma and several other medications for patients with kidney disease or hospitalized on ventilators.

 

The FDA also gave hydroxychloroquine and chloroquine an emergency use authorization March 28 after case studies in France indicated that it showed promise and President Donald Trump began pushing it as a potential "game-changer" in the fight against COVID-19. But the designation was revoked June 15 after the FDA determined the medications were "unlikely to be effective in treating" the illness.

 

The Tricare change could facilitate beneficiaries' access to a COVID-19 vaccine at little to no cost, as it is expected that the FDA will issue an emergency use authorization for a vaccine if one of the six candidates under study is deemed effective and safe.

 

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The Coronavirus Aid, Relief and Economic Security, or CARES, Act designated the COVID-19 vaccine a preventive health service, requiring private insurers and Medicare to cover the entire cost, but Tricare is not mentioned under the legislation.

 

Under the temporary Tricare change, patients will be covered for both the experimental medications and the associated treatment. Normally, beneficiaries who are receiving a medication under investigational use -- also called compassionate use -- must pay the entire cost of a non-covered drug and it would not apply to their catastrophic cap.

 

Tricare officials said copayments for these medications will depend on a beneficiary's Tricare plan, provider and location of care. They did not say whether the medications would be considered "non-formulary," which require the highest copayments

 

In the same announcement, Defense Health Agency officials said they are waiving the three-day hospitalization prerequisite for patients to access skilled nursing facility care during the pandemic.

 

[RELATED: Flu Shot 2020: Full Details for VA, TRICARE Availability]

 

Under normal circumstances, Tricare covers care in skilled nursing facilities -- rehabilitation or other in-patient medical treatment centers -- if a patient needs it after a hospital stay or within 30 days of a hospital discharge.

 

The temporary change during the pandemic will "align the Tricare benefit with Medicare ... which waived its three-day prior hospital stay requirement during the COVID-19 pandemic," according to a Tricare official.

 

The U.S. military has played a major role in the study of at least one investigational treatment for COVID-19: convalescent plasma. The DoD has embarked on an effort to collect 8,000 to 10,000 units of plasma from recovered coronavirus patients. Researchers are using the blood product, which contains antibodies to the virus, with the hope of bolstering a sick patient's immune response.

 

More than 65,600 people affiliated with the Defense Department have tested positive for COVID-19, but just 2% of those have required hospital treatment, including 613 military personnel, 131 military dependents, 435 civilian employees and 180 defense contractors.

 

As of Monday, eight military personnel, seven dependents, 59 civilians and 22 contractors had died.

 

The Army has recorded the largest number of coronavirus cases since the pandemic began: 16,742 as of Monday. The Navy has had 10,174 cases; the Air Force, 7,066; and the Marine Corps, 5,675.

 

The National Guard has logged 5,242 cases.

 

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