U.S. representatives question cost-effectiveness of TRICARE mail-order pharmacy program

Several Congress members are concerned about the Department of Defense’s (DoD) use of the TRICARE mail-order pharmacy program administered by Express Scripts.

In a letter to the DoD’s Office of Inspector General on August 3, the U.S. representatives requested an audit of the mail-order program, which must be completed within 6 months. Representatives who signed on to the letter include: Reps. Walter B. Jones (R-NC), Michael H. Michaud (D-ME), Larry Kissell (D-NC), Martha Roby (R-AL), Renee Elmers (R-NC), Austin Scott (R-GA), Dave Loebsack (D-IA), and Steven Palazzo (R-MS).

“For years, the TRICARE pharmacy co-payment structure has encouraged the use of mail order,” the representatives wrote. In addition, co-payments changes that went into effect October 1, 2011, and the FY2013 National Defense Authorization Act provide greater incentives for beneficiaries to obtain prescription drugs from TRICARE’s mail-order pharmacy, according to the representatives.

“Given these efforts to increase the use of mail order in the TRICARE pharmacy program, we would like to better understand what controls are in place to ensure the TRICARE mail-order program is providing prescription drugs to beneficiaries in the most efficient and cost-effective manner,” the representatives wrote.

In the audit, the representatives want the DoD to answer the following questions:

• Can TRICARE beneficiaries opt-out of automatic refill programs?

• Is higher utilization of mail order resulting in waste and increased healthcare costs for the DoD?

• How effectively are patients utilizing their medications?

• How is TRICARE measuring adherence?

• What controls are in place to ensure patients do not receive medications that they no longer need?

• What processes exist to halt the shipment of medications when types of medication, dosage, strength, or other changes are made by a patient’s physician?

The Congress members have asked for the audit and a report on its results to be completed in 180 days.