DoD Updates Its Uniform Formulary

Since 11-09-05

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Subject: Fw: TMA News Release: DoD Updates Its Uniform Formulary- November 8, 2005 

Subj: TMA News Release: DoD Updates Its Uniform Formulary- November 8, 2005
Date: 11/8/2005 4:49:42 PM Eastern Standard Time
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DoD Updates Its Uniform Formulary

November 8, 2005 No. 05-42

FALLS CHURCH, Va. - Dr. William Winkenwerder Jr., assistant secretary of defense for Health Affairs and director of TRICARE Management Activity approved the addition of three therapeutic classes of medications used to treat benign prostatic hypertrophy (enlargement) and cardiovascular disease to the TRICARE Uniform Formulary.

Additionally, he approved moving 16 medications to non-formulary status over the next few months. The TRICARE Uniform Formulary (UF) is a set of medications approved by the Department of Defense for distribution throughout the Military Health System. Drugs are grouped into three tiers: formulary generic (tier one), formulary brand name (tier two) and non formulary (tier three).

Beneficiaries’ copayments are based on a medication’s grouping within the UF.The UF process involves the review of different classifications of FDA-approved medications on the basis of their clinical and cost effectiveness. After careful analysis, the Department of Defense (DoD) Pharmacy and Therapeutics (P&T) Committee recommends medications as formulary or non-formulary. The P&T Committee is composed of physicians, pharmacists and representatives from the Services and the Veterans Administration.

The Beneficiary Advisory Panel (BAP), whose membership includes representatives of active duty families and retirees, civilian health care professionals and those supporting the health care benefit through contracts, comments on the P&T Committee’s recommendations. The BAP expressed concern about the selection of ramipril (Altace®) for non-formulary status.

After a thorough assessment, the P&T Committee determined that while Altace® is important in the treatment of some patients, it is no more clinically effective than the alternatives in a majority of patients. “The selection of Altace® for non-formulary status was the single most difficult decision at the Committee’s August meeting,” said Captain Patricia Buss, chairperson of the P&T Committee.

“The Committee did recognize that there is an important role for Altace® in the treatment of some high-risk patients with a history of cardiovascular disease and the drug will be available at the formulary cost share if medical necessity is documented.” Beneficiaries may refer to this chart displaying the different formulary drugs and the corresponding non-formulary equivalents.

TRICARE beneficiaries will pay $22 for up to a 30- or 90-day supply for non-formulary medications, depending on whether they fill the prescription at a TRICARE Retail Network Pharmacy (TRRx) or through the TRICARE Mail Order Pharmacy (TMOP). Beneficiaries will pay the higher of $22 or 20 percent in retail non-network pharmacies.

Patients currently using the newly designated non-formulary medications may wish to consult their doctor about formulary alternatives or if a medical necessity is appropriate for them. If medical necessity is established for using non-formulary medications, patients may qualify for the $9 copayment for up to a 30-day TRRx supply or up to a 90-day TMOP supply.

Military treatment facilities (MTF) will no longer carry these or other non-formulary medications on their local formularies. Non-formulary medications may be available at MTFs only when medical necessity is established and the prescription was written by a MTF provider. Active duty members have no copays and, unless medical necessity is established, they may not obtain non-formulary drugs.

Medical necessity forms are available on the TRICARE Pharmacy Web site at www.tricare.osd.mil/pharmacy/medical-nonformulary.cfm. Procedures for completing and submitting medical necessity information may be found on these forms.Eligible beneficiaries may fill prescriptions for non-formulary and covered medications through the TMOP and TRRx pharmacies.

Beneficiaries may reduce out-of-pocket expenses by filling prescriptions through the TMOP where beneficiaries may receive up to a 90-day supply of medicine for the same cost as a 30-day supply in the TRRx. For more information about TMOP, eligible beneficiaries may visit the Express-Scripts Inc.

Web site at www.tricare.osd.mil/pharmacy/tmop_contact.cfm or they may call (866) DOD-TMOP, (866) 363-8667. Beneficiaries may also contact the TRRx customer service line at (866) DOD-TRRX, (866) 363-8779, or visit www.tricare.osd.mil/pharmacy/trrx_contact.cfm.

For additional information about various medications, their availability and cost, beneficiaries may use the TRICARE Formulary Search Tool at: www.tricareformularysearch.org/dod/medicationcenter/default.aspx.

 http://www.tricare.osd.mil/news/2005/news0542.cfm
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Contributed,
YNCS Don Harribine, USN(ret)