Beginning in January, Tricare will require patients using its mail order pharmacy to confirm that they want their prescriptions refilled, rather than sending them automatically.
Express Scripts, Tricare's pharmacy benefits manager, began notifying patients last week of the pending change. According to the email, Tricare Mail Order Pharmacy users will receive a notification via email or text when their prescription is up for a refill and must log in to confirm the request.
Once authorized, Express Scripts will send the medication.
If a beneficiary turns down a refill or does not respond, the prescription will be removed from the automatic refill program, but Express Scripts will continue sending reminder notifications until the prescription expires, according to Defense Health Agency spokesman Peter Graves.
Graves said the DHA directed Express Scripts to institute the approval system to "ensure Tricare beneficiaries are receiving refills on medication when needed and to prevent excess waste."
Express Scripts is the target of a lawsuit filed by the federal government under the False Claims Act that charges it delivered excess prescription drugs to military beneficiaries through the Tricare Mail Order Pharmacy system and profited at the expense of the Defense Department.
The suit, filed in 2019 and unsealed this year, alleges that the company's system purposefully sent 90-day refills at the 60-day mark, effectively issuing patients 73% more tablets than prescribed over a year.
The DHA spent $7.4 billion on the Tricare drug program in 2021, including $3.2 billion on mail order medications, $1.5 billion at military pharmacies and $2.7 billion in retail stores. A decade ago, the DoD spent nearly $7 billion on the program, but mail order prescriptions made up just 20% of that cost.
Prescription copayments for medications through Tricare will remain the same in 2023. Tricare beneficiaries who use the mail order system will pay $12 for a generic drug, $34 for a brand-name drug and $68 for a non-formulary medication for a 90-day prescription.
Copayments for a 30-day prescription at a retail pharmacy will remain at $14 for a generic, $38 for a brand name and $68 for a specialty medication not in Tricare's formulary.
Graves said that, in addition to notifying patients through emails and phone calls, Express Scripts has issued notices through social media and the MilitaryRx blog.
-- Patricia Kime can be reached at Patricia.Kime@Military.com. Follow her on Twitter @patriciakime