TRICARE PILOT PHARMACY BENEFIT ANNOUNCED FOR MEDICARE-ELIGIBLE, AGE-65-AND-OLDER MILITARY RETIREES

On August 5, 1999, two sites were selected by a random drawing for a TRICARE pharmacy redesign pilot study specified in the National Defense Authorization Act for Fiscal Year 1999. The counties selected were Okeechobee, Fla., and Fleming, Ky. Members of the Military Coalition and Alliance participated in the randomized selection.

The pilot program will make network retail and mail order pharmacy benefits available to DoD beneficiaries in the demonstration areas who are Medicare-eligible, age 65 and older, and who have Medicare Part B. To be eligible for the program, potential enrollees must live in designated zip codes in and around these counties. It is anticipated that services will begin in the spring of the year 2000.

"The pharmacy benefit pilot program is one of several programs being tested by DoD across the country to expand healthcare access for military retirees," said Dr. Sue Bailey, assistant secretary of Defense for Health Affairs. "This new pharmacy demonstration program helps solve the problem of high out-of-pocket healthcare costs for our age-65-and-older beneficiaries who do not have access to a MTF and who do not have a prescription benefit through other health insurance. For our retirees in these pilot areas, prescriptions will finally be affordable under this program."

To comply with the 1999 legislation, the new benefit will be offered in two counties that were selected based on two criteria. First, the two sites had to be non-catchment areas - these are areas lacking a military treatment facility (MTF). Second, one site required a high presence of health maintenance organizations (HMOs) in the area, and the other required a low presence of HMOs. Sometimes HMOs offer a pharmacy benefit to Medicare-eligible enrollees, and by taking into account their presence in the site selection, the DoD can study relationships between private HMO benefits and the pilot DoD pharmacy benefit.

	Both network retail and mail order prescription services will be available in the pilot program. Beneficiaries may choose to continue their use of Military Treatment Facility pharmacies. The pilot benefit incorporates no financial limit on drug purchases. An enrollment fee and co-payments for drugs purchased under the program will be charged.

Enrollment is expected to begin in spring of the year 2000. DoD Medicare-eligible beneficiaries, age 65 and older may call their TRICARE Service Center to find out if their zip code falls within the jurisdiction of the pilot program. Eligible beneficiaries in the designated zip codes may enroll. Zip code information is also available on the TRICARE web site at http://www.tricare.osd.mil.

For more information, TRICARE representatives for the Okeechobee, Fla., area can be reached at (800) 444-5445; and for the Fleming, Ky., area at (800) 941-4501. Customer service representatives will be able to let callers know when they may start enrolling in the program.