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This final rule implements section 702 (c) of the Carl Levin and Howard P. Buck” McKeon National Defense Authorization Act for Fiscal Year 2015 which states that beginning October 1, 2015, the pharmacy benefits program shall require eligible covered beneficiaries generally to refill non-generic prescription maintenance medications through military treatment facility pharmacies or the national mail-order pharmacy program. Section 702(c) of the National Defense Authorization Act for Fiscal Year 2015 also terminates the TRICARE For Life Pilot Program on September 30, 2015. The TRICARE For Life Pilot Program described in section 716 (f) of the National Defense Authorization Act for Fiscal Year 2013, was a pilot program which began in March 2014 requiring TRICARE For Life beneficiaries to refill non-generic prescription maintenance medications through military treatment facility pharmacies or the national mail-order pharmacy program. TRICARE for Life beneficiaries are those enrolled in the Medicare wraparound coverage option of the TRICARE program. This rule includes procedures to assist beneficiaries in transferring covered prescriptions to the mail order pharmacy program.

Overall Description of Deadline: Section 702 (c) of the Carl Levin and Howard P. Buck McKeon National Defense Authorization Act for Fiscal Year 2015 states that beginning October 1, 2015, the pharmacy benefits program shall require eligible covered beneficiaries generally to refill non-generic prescription maintenance medications through military treatment facility pharmacies or the national mail-order pharmacy program. Section 702(c) also terminates the TRICARE For Life Pilot Program on September 30, 2015.

Statement of Need:

The DoD interim rule established processes for the new program of refills of maintenance medications for all non-active duty TRICARE beneficiaries through military treatment facility pharmacies and the mail order pharmacy program.

Summary of the Legal Basis:

This regulation is established under the authorities of 5 U.S.C. 301; 10 U.S.C. ch 55; 32 CFR section 199.21.

Alternatives:

The rule fulfills a statutory requirement, therefore there are no alternatives.

Anticipated Costs and Benefits:

The effect of the statutory requirement, implemented by this rule, is to shift a volume of prescriptions from retail pharmacies to the most cost-effective point-of-service venues of military treatment facility pharmacies and the mail order pharmacy program. This will produce savings to the Department of approximately $88 million per year, and savings to beneficiaries of approximately $16.5 million per year in reduced copayments. Updated and more in-depth economic data will be provided with the final rule.

Risks:

Not finalizing this rule would risk a loss of savings to both the Department and beneficiaries. There is no risk to the public.