Determinants of Dispensing Location in the TRICARE Senior Pharmacy Program
Abstract
The MHS serves approximately 8.6 million eligible beneficiaries, including active-duty military personnel and their family members (dependents), retired military personnel and their dependents, and surviving dependents of deceased military personnel. TRICARE, the program that administers health care for the DoD, includes a pharmacy benefit that provides coverage for virtually all U.S. Food and Drug Administration (FDA) approved prescription medications. Prior to fiscal year (FY) 2001, elderly military retirees and their dependents who wished to use their military benefits to fill a prescription could do so only at a MTF outpatient pharmacy; However, some drugs that were frequently prescribed by civilian providers were not always available at MTFs because of formulary restrictions. As of FY 2001, DoD introduced a new program for elderly military retirees and their dependents, entitled TRICARE Senior Rx (TSRx). TSRx beneficiaries can now fill their prescriptions at any of four points of service: (1) outpatient pharmacies at MTFs; (2) the TRICARE Mail Order Pharmacy (TMOP), 3 currently administered by Express Scripts Inc.; (3) retail pharmacies contracted by regional TRICARE contractors (referred to as "network" pharmacies); and (4) non-network retail pharmacies. The TMOP dispenses drugs for chronic conditions. Although it cannot dispense a few drugs, such as atorvastatin, without proof of medical necessity the overwhelming majority of drugs for chronic conditions are available. Retail pharmacies have completely open formularies: TRICARE reimburses them for all prescriptions except those specifically excluded from TRICARE coverage.
Document Details
- Document Type
- Technical Report
- Publication Date
- Jan 01, 2005
- Accession Number
- ADA432290
Entities
People
- Geoffrey Joyce
- Jennifer Pace
- Jesse D. Malkin
- Thomas Croghan
Organizations
- RAND Corporation