MOAA’s message to a Senate panel scrutinizing the TRICARE Pharmacy Program stressed the need to preserve affordable access to medications, rebuild the brick-and-mortar pharmacy network, and restore coverage for GLP-1 medications to TRICARE For Life (TFL) users.

Senate Armed Services Personnel subcommittee members scrutinized terms of the fifth-generation pharmacy contract, referred to as TPharm5, during the July 15 hearing and emphasized the importance of robust access to affordable prescription medications for servicemembers and retirees, as well as their families and survivors.

In its statement for the record (SFR), MOAA expressed appreciation for the committee’s oversight and urged Congress to strengthen protections for beneficiaries as pharmacy policies continue to evolve.

“Broad pharmacy access, comprehensive medication coverage, and affordable copays have long been hallmarks of the TRICARE Pharmacy Program, but these core benefits have suffered steady erosion in recent years,” MOAA wrote. “While MOAA acknowledges the need for cost containment, any pharmacy reforms must preserve the high standard of access, coverage, and affordability that honors our nation’s commitment to those who serve.”

[MORE FROM THE HEARING: Senators Question Whether Military Pharmacy Program Is the Best Deal for Beneficiaries]

Subcommittee leadership acknowledged concerns that changes to the pharmacy benefit can have negative implications for military families. Sen. Elizabeth Warren (D-Mass.), the subcommittee’s ranking member, noted that “the consequences of losing access to your local pharmacy can be immeasurable,” reflecting concerns raised by beneficiaries affected by TRICARE retail pharmacy network reductions.

Subcommittee Chairman Sen. Tommy Tuberville (R-Ala.) emphasized the need to balance fiscal responsibility with beneficiary access.

“We must strike the right balance between controlling costs and maintaining access,” Tuberville said. “Savings achieved on paper are not real savings if they result in delayed treatment, reduced readiness, or additional health care costs down the road.”

[READ: MOAA's Statement for the Record]

MOAA’s SFR outlined four key priorities for congressional oversight and legislative action:

Restore GLP-1 Coverage for TRICARE For Life

Reinstating TRICARE Pharmacy Program coverage of GLP-1 medications for eligible TFL beneficiaries remains one of MOAA’s top legislative priorities. MOAA urged Congress to ensure the Defense Health Agency (DHA) has the statutory authority and appropriations necessary to reverse the 2025 policy change.

MOAA has seen extraordinary levels of engagement from both impacted patients who have lost GLP-1 coverage and other beneficiaries who fear future cuts to the retiree health care benefit. More than 800 TRICARE beneficiaries have contacted MOAA to share their feedback on the decision to revoke coverage of certain GLP-1 drugs from TFL beneficiaries.

[TAKE ACTION: Restore TRICARE For Life Coverage of GLP-1 Medications]

MOAA’s statement noted the inequity this policy creates between TFL and TRICARE Prime and Select coverage, the inconsistency with statutory guidance for the TRICARE Pharmacy Program, and the negative impact on beneficiaries.

We also noted TFL policy is out of step with Medicare efforts to expand access to affordable GLP-1s through the Medicare Bridge program.

[RELATED: New Medicare GLP-1 Program Excludes TRICARE For Life Beneficiaries]

Ensure Access to Medically Necessary Medications

MOAA urged Congress to ensure DHA implements a medical necessity review process for medications placed in TRICARE’s Tier 4 (Non-Covered) category.

Although Congress directed DHA to establish such a process in Senate report language accompanying the FY 2022 National Defense Authorization Act (NDAA), beneficiaries have no mechanism to request a medical necessity review for a Tier 4 medication when other formulary alternatives have failed.

Instituting such an exception process would bring TRICARE in line with commercial health plan benchmarks  – such as the Blue Cross and Blue Shield Service Benefit Plan, better known as FEP Blue – while protecting military families with unique medical needs.

Restore the TRICARE Retail Pharmacy Network

The SFR renewed MOAA’s call to restore the retail pharmacy network after reductions under TPharm5 significantly narrowed beneficiary access and choice.

While additional pharmacies have been added since the initial cuts, it remains well below its pre-TPharm5 size.

[RELATED: Find a Network Pharmacy Near You]

MOAA successfully advocated for an independent review of the network cuts during our 2023 Advocacy in Action event. The resulting Government Accountability Office report showed at least 380,000 beneficiaries lost a pharmacy they had recently used while 98,000 beneficiaries were knocked out of distance-based access standards due to the network cuts. The narrowed network disproportionately affected elderly patients, rural residents, and beneficiaries with complex medical needs.

MOAA has called for greater transparency on savings generated by TPharm5, urging Congress to require DHA to distinguish between savings attributable to retail network reductions from those generated by other contract reforms, including specialty medication fulfillment.

Preserve Affordable Pharmacy Copays After 2027

DHA can adjust pharmacy copays beginning in 2028 without any requirement to consider prevailing commercial health plan cost-sharing practices or the impact of higher copayments on military beneficiaries. This creates the potential for disproportionate beneficiary copay increases on prescription medications.

MOAA is urging Congress to provide statutory guardrails on DHA authority to adjust pharmacy copays and protect beneficiaries from disproportionate copay increases in the future.

What’s Next

Unlike health care services that are used only occasionally or rarely, the pharmacy benefit is part of daily life for many. For this reason, even modest reductions in coverage, access, or affordability can have outsize effects on health outcomes, financial security, and confidence in the TRICARE program.

As Congress continues its oversight of the TRICARE Pharmacy Program, MOAA will continue to advocate for policies that preserve broad pharmacy access, medically appropriate coverage, and affordable cost-sharing so the program delivers on the health care benefit to those who have served and their families.