Congress is promising to launch a sweeping reform of the military health system next year, but lawmakers still made a few near-term tweaks to military medical policy in the 2016 Defense Authorization Act signed by President Obama just before Thanksgiving.

Among those tweaks: An increase in the amount some Tricare beneficiaries will pay for prescription drugs, and new programs designed to improve patient care.

Under the new law, Tricare beneficiaries who fill their prescriptions at retail pharmacies or order brand-name medications through the mail system will see their co-pays rise in the coming weeks.

A 30-day prescription for generic drugs from a network pharmacy will rise to $10, a $2 bump, while a brand-name prescription will rise to $24, up from $20.

A 90-day prescription for a brand-name medication by mail will cost $20, up from $16, and medications not on Tricare's formulary will increase to $49, up from $46.

Generics will still be available at no cost through mail, as will all prescriptions filled at military pharmacies.

The new law also requires Defense and Veterans Affairs department pharmacies to stock the same medications to treat pain, sleep disorders and psychiatric conditions, starting June 1.

That change is designed to ensure troops leaving active duty have continuity of medications when they transition out of the military and into VA care. Discrepancies between the departments' pharmacy formularies have caused problems for some veterans who were unable to get the exact formulation of medications they had been prescribed on active duty when they shifted to VA care.

The law also contains several provisions aimed at improving patient access to care, including a requirement for DoD to develop a three-year pilot program that would let Tricare beneficiaries go to an urgent care clinic up to four times a year without having to get a referral from their primary care physician or network.

The pilot program will require Tricare's nurse advice line to advise beneficiaries on how to get care at the "most appropriate level," to include helping patients decide whether they should go to an emergency room or urgent care facility, or wait for regular doctor's hours.

The law also requires DoD to implement a pilot program using "value-based incentives" to pay providers, meaning payments to physicians and providers participating in the program will focus on patient outcomes and other metrics rather than volume.

The law says that program must be similar to value-based incentive programs offered by Medicare that are designed to eliminate waste in health spending.

The legislation also makes some changes to improve beneficiaries' access to mental health providers, including expanding the list of mental health counselors eligible for reimbursement by Tricare to include counselors who hold master's degrees or doctorates in mental health counseling or clinical mental health counseling from one of 10 accrediting bodies.

It also requires DoD to develop a plan to compile and assess data on mental health services and treatment at military medical facilities; and orders the Pentagon to develop a system for designating civilian mental health providers as having the skills and understanding to treat the unique needs of service members.

Sen. Joe Donnelly, D-Ind., who pressed for the changes to mental health services, said the nation "owes it to our service members and their families to help them get access to best quality mental health care."

"Our work is far from done, and I will keep pushing to improve mental health care for our service members, veterans and their loved ones," Donnelly said after the bill was signed by Obama.

The new legislation has some new requirements for DoD to publish patient safety data for military hospitals and clinics on the Internet, although a number of such measures already are available on Tricare's website, including those on inpatient performance sent to the Joint Commission, a nonprofit that accredits and certifies hospitals and health care programs, and outpatient data regarding information on preventive health services.

New data that will become available under the law include patient safety, quality of care, patient satisfaction and health outcomes data.

Other health care provisions in the bill include:

  • The DoD must establish clinical practice guidelines for its health care providers on standards of care for birth control.
  • The DoD must furnish any research or surveillance data conducted by the department on burn pits and environmental exposures to the Department of Veterans Affairs.
  • The Government Accountability Office is required to do a study on gambling among service members, to include risks, available treatment and financial counseling for those affected.
About Patricia Kime

Patricia Kime is a senior writer covering military and veterans health care, medicine and personnel issues.

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