Copay Deliberations Stall Defense Bill

Senate draft of the 2016 NDAA includes copay hikes for brand-name and non-formulary medications.

Disagreements between federal lawmakers about Tricare copayments have delayed the passage of the 2016 National Defense Authorization Act (NDAA).

In support of Pentagon budget recommendations calling for increased copayments for Tricare for Life, a military health care program for retired veterans, the Senate draft of the 2016 NDAA included copay hikes for brand-name and non-formulary medications. The House of Representatives, however, opposed these increases.

In a memo sent to his fellow committee Republicans, Representative Mac Thornberry (R-TX), chairman of the House Armed Service Committee, stated that the military health care budget accounts could be balanced without the copay increases, but he expressed willingness to compromise on the issue in order to avoid debates regarding reforms of the military retirement system.

“The House is willing to consider modest Tricare copay adjustments, but only enough to prevent a point of order on the Senate floor related to the retirement system,” Rep. Thornberry wrote. “They would be roughly 30% of the Senate proposal. The House is unwilling to accept 100% of proposed increases.”

Instead of raising Tricare copayments, the House draft of the NDAA included a “preferred pharmacies” pilot program aimed at reducing government costs. This proposal was praised by National Community Pharmacists Association CEO B. Douglas Hoey, RPh, MBA, who applauded the pilot program as an effort to improve patient access to medication.

“We appreciate the committee’s dedication to supporting both patient access to care as well as meaningful participation of small business community pharmacies in this taxpayer-funded program,” Hoey said in a statement.

If both houses of Congress ultimately agree upon a copay hike, it would mark the third instance in which medication copays have increased for military families and retirees in the last 4 years, including a $3 increase that took effect earlier this year.

On May 1, 2015, Tricare contractor Express Scripts began to screen the ingredients of compounded drugs to ensure that they are covered by Tricare, FDA approved, and not excessively priced.

Although members of Congress have left for their summer recess, Rep. Thornberry plans to continue negotiating with his Senate counterpart, Senator John McCain, (R-AZ), throughout the break.

When Congress reconvenes in September, congressional leaders aim to finalize the NDAA before the new fiscal year begins on October 1.