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DOD/DODOASHA

RIN: 0720-AB60

Publication ID: Fall 2014

Title: CHAMPUS/TRICARE: Pilot Program for Refills of Maintenance Medications for TRICARE For Life Beneficiaries Through the TRICARE Mail Order Program
Abstract: This interim final rule implements section 716 of the National Defense Authorization Act for Fiscal Year 2013 (Pub. L. 112-239), which establishes a 5-year pilot program that would generally require TRICARE for Life beneficiaries to obtain all refill prescriptions for covered maintenance medications from the TRICARE mail order program or military treatment facility pharmacies. Covered maintenance medications are those that involve recurring prescriptions for chronic conditions, but do not include medications to treat acute conditions. Beneficiaries may opt out of the pilot program after 1 year of participation. This rule includes procedures to assist beneficiaries in transferring covered prescriptions to the mail-order pharmacy program. This regulation is being issued as an interim final rule in order to comply with the express statutory intent that the program begin in calendar year 2013.
Agency: Department of Defense(DOD)	Priority: Economically Significant
RIN Status: Previously published in the Unified Agenda	Agenda Stage of Rulemaking: Final Rule Stage
Major: Yes	Unfunded Mandates: No
CFR Citation: 32 CFR 199
Legal Authority: 5 USC 301 10 USC ch 55

Legal Deadline: None

Statement of Need:

The Department of Defense (DoD) proposed rule establishes processes for the new program of refills of maintenance medications for TRICARE for Life beneficiaries through military treatment facility pharmacies and the mail order pharmacy program.

Summary of the Legal Basis:

This regulation is proposed under 5 U.S.C. 301; 10 U.S.C. chapter 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 $104 million per year, and savings to beneficiaries of approximately $34 million per year in reduced copayments.

Risks:

Loss of savings to both the Department and beneficiaries. No risk to the public.

Timetable:

Action	Date	FR Cite
Interim Final Rule	12/11/2013	78 FR 75245
Interim Final Rule Comment Period End	02/10/2014
Interim Final Rule Effective	02/14/2014
Final Action	01/00/2015

Regulatory Flexibility Analysis Required: No	Government Levels Affected: None
Small Entities Affected: Businesses	Federalism: No
Included in the Regulatory Plan: Yes
RIN Data Printed in the FR: No
Agency Contact: George Jones Department of Defense Office of Assistant Secretary for Health Affairs Defense Pentagon, Washington, DC 20301 Phone:703 681-2890