MOAA’s TRICARE Pharmacy Work Tackles Tier 4 Coverage, Out-of-Stock Concerns

MOAA’s TRICARE Pharmacy Work Tackles Tier 4 Coverage, Out-of-Stock Concerns
Photo by Airman 1st Class Yosselin Perla/Air Force

MOAA recognizes one of the most valuable aspects of your military health care benefit is the TRICARE pharmacy program, so protecting the pharmacy benefit is a top priority. Our recent advocacy efforts on Capitol Hill and with the Defense Health Agency (DHA) have focused on securing an appeals process for TRICARE Tier 4 or non-covered drugs.

 

MOAA also works regularly with Express Scripts, the pharmacy benefits manager for TRICARE, to address beneficiary issues and seek program improvements. One issue we have been busy working is TRICARE Pharmacy Home Delivery out-of-stocks: Mail order program out-of-stocks mean higher copays and a hassle for beneficiaries who are forced to transfer their out-of-stock prescriptions to a retail pharmacy, at least temporarily, to get their medications filled.

 

Why are some medications out-of-stock for mail order yet still available at retail outlets? Military treatment facility (MTF) pharmacies and the TRICARE home delivery program obtain medications via a contract administered by the Defense Logistics Agency (DLA). These medications must meet sourcing requirements outlined in federal law. The DLA contract also provides DoD with prescription drugs at favorable pricing, but it sometimes encounters supply problems that retail pharmacies don’t experience. You can learn more about the procurement process for MTF pharmacies/the TRICARE Mail Order Pharmacy program at this link.

 

[RELATED: MOAA's 2020-21 TRICARE Guide]

 

Based on feedback from MOAA members and other TRICARE beneficiaries frustrated with mail order program out-of-stocks, Express Scripts, DHA, and DLA have worked together to improve out-of-stock rates. Since MOAA began working with Express Scripts on this issue, the TRICARE mail order prescription out-of-stock rate has been reduced by two-thirds. This has been reflected in far fewer calls to MOAA’s Member Service Center about prescription out-of-stocks.

 

MOAA has also taken this issue to the Hill – it would require legislation to reduce TRICARE retail pharmacy copays for mail order prescriptions that are out-of-stock, and we are pursuing this fix.

 

Do you have any questions or feedback about the pharmacy program? Please consider registering for Making Your TRICARE Pharmacy Benefit Work for You, a July 22 webinar hosted by Military OneSource. You can register at this link

 

MOAA is also interested in hearing your perspectives on the TRICARE pharmacy program. Please share your feedback at legis@moaa.org.

 

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About the Author

Karen Ruedisueli
Karen Ruedisueli

Ruedisueli is MOAA’s Director of Government Relations for Health Affairs and also serves as co-chair of The Military Coalition’s (TMC) Health Care Committee. She spent six years with the National Military Family Association, advocating for families of the uniformed services with a focus on health care and military caregivers.