Five percent of Tricare users who previously received automatic prescription refills by mail didn't renew their drugs under a new policy requiring them to confirm the orders, according to the Defense Health Agency.
Those patients either disenrolled or didn't consent to renew their prescription between January and the end of March, which was the first three months of the new refill policy, DHA spokesperson Peter Graves told Military.com by email.
Express Scripts, Tricare's pharmacy benefits manager, notified Tricare users in December that it would stop automatically sending medications via mail order unless patients manually confirm each time. The change was in part to reduce medication waste and save beneficiaries money, Graves said.
"If a prescription is disenrolled, Express Scripts will hold the prescription until a refill is requested or until the prescription expires," he said.
The federal government is suing Express Scripts for allegedly sending out too much medication, claiming the mail order pharmacy program sent 90-day refills every 60 days, giving patients 73% more tablets than prescribed in a year.
Express Scripts says it has more than 9 million active-duty service members, retirees and their families in the Tricare Pharmacy Program, though the DHA did not provide the actual number of those who rely on auto refills.
Maintenance medications -- those taken for a long period of time or indefinitely -- in particular must be received by mail or in an on-base pharmacy after the initial refill. Prescriptions sent by mail cost substantially less than refilling them in a retail pharmacy.
Reminders are going out in advance of an automatic refill's scheduled shipping date via beneficiaries' preferred communication method -- email, text message or phone call -- and patients must confirm that they want the prescription.
Of the patients enrolled in the mail-order pharmacy program in December 2022, 67% were getting automatic refills, Graves said. As of March, that overall percentage had fallen to 65.
Graves said now is too soon to assess whether the reductions constitute a trend and that possible causes could include change in medication dosage or patients no longer needing prescriptions.
The DHA published a how-to guide on approving the automatic refills in April.
Patients who don't consent to their refill get disenrolled from the automatic-refill program, though Express Scripts will continue to send reminders until the prescription expires. Patients can reenroll in automatic refills by logging in their account.
Tricare pharmacy copayments are set to go up in 2024. A 90-day supply received by mail of a generic drug will go up from $12 to $16 for generic drugs and from $34 to $43 for name brands.
-- Amanda Miller can be reached at amanda.miller@military.com.
