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Editor’s Note: This article is part of the 2023-24 TRICARE Guide for Insurance Plans Administered by Association Member Benefit Advisors (AMBA). A version of this guide was published in the November 2023 issue of Military Officer magazine.
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Tricare For Life Pharmacy Network
You should be aware of TRICARE pharmacy network outages, even if they do not affect you. The transition to the new TRICARE pharmacy contract caused the retail pharmacy network to shrink by nearly 25%, as thousands of independent pharmacies and Kroger-affiliated stores left the network due to unaffordable reimbursement rates.
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You probably won’t be affected by this change. Only a small number of TRICARE beneficiaries filled their prescriptions at one of the selling pharmacies in the last six months. So why should you worry?
These in-network cuts are cuts to military health benefits earned through service and sacrifice and send a clear message: the TRICARE coverage you rely on is at risk. A reduced pharmacy network reduces choice and selection for all TRICARE beneficiaries. If you’re part of most healthy families, switching to another network pharmacy to get the medications you occasionally need may not be a problem. However, pharmacy options are important to many military families.
Choice is important for seniors. Seniors often have limited mobility as well as mobility, vision or hearing problems and depend on the enhanced services offered by community pharmacies.
For rural dwellers, choice matters. Many rural areas do not have large chain stores. Families in rural areas depend on their local pharmacies, and now military families and retirees must go through their local pharmacy and/or Walmart to get to chain pharmacies much further away.
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Your options after hospitalization are important. Many of the out-of-network pharmacies are located in hospital lobbies or other healthcare facilities, making it easier for patients to obtain medications in difficult situations.
When there are drug shortages, options are important. Problems in the prescription drug supply chain are becoming more common. As your network shrinks, your chances of finding the drugs you need in network diminish.
Options are important after a serious diagnosis or when unusual medications are needed. Members report that independent pharmacies generally prefer over-the-counter and special-order drugs to larger chains.
For long-term care residents, options matter. Assisted living facilities use a single pharmacy that delivers specially packaged prescriptions to all residents to reduce medication administration errors. A strong network increases the likelihood that your long-term care pharmacy will be included in the network. Otherwise, as many distraught families have learned, you’ll have to pay 100% of the cost of the drug out of pocket and apply for a partial refund.
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Pharmacy options for military families are now significantly reduced compared to 20 years ago, when the program had more than 50,000 retail stores in its network.
These pharmacy cuts may not affect you directly, but they send a message to all military families: Your TRICARE benefits are at risk.
Which version of TRICARE do you want to use when you need it? Is it an affordable, robust, high-quality cover/access version that has been around for 20 years while many of you have served multiple combat deployments, or is it a stripped-down version that hurts your family when you need it most?
Over the past year, we’ve raised awareness of this issue and advocated for a report assessing the impact of pharmacy network cuts on beneficiaries. This effort achieved language in the House and Senate versions of the National Defense Authorization Act for fiscal year 2024. We are working to ensure that the final version of the bill includes a reporting requirement. The findings of this report will inform our future advocacy efforts.
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Rudisuelli serves as Director of Government Relations for Health Affairs and Co-Chair of the Military Coalition Medical Committee (TMC). She advocated for military families for six years at the National Military Family Association, focusing on military health care and caregivers.
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