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There is one formulary, the TRICARE Uniform Formulary, that applies to both Military Treatment Facilities (MTFs) and retail locations with two additional subset formularies that apply exclusively to MTFs. |
One common point of confusion is the drug formulary for the Department of Defense (DOD). Whether it is the process by which it is managed or how TRICARE is involved, it is important for pharmaceutical manufacturers to understand how placement on the TRICARE Uniform Formulary (UF) (sometimes referred to as the TRICARE Formulary) impacts a patient’s access to its product.
At the heart of the DOD healthcare system, which serves active military members and their families, lies TRICARE, a health insurance-like program that beneficiaries can use either within the Military Health System (MHS) Military Treatment Facilities (MTFs) or through community care providers. The TRICARE UF applies to prescription drugs regardless of whether a prescription is filled through a MTF, the mail order process, or a commercial retail location that accepts TRICARE.
To optimize cost-effectiveness while simultaneously ensuring necessary and appropriate access to prescription medications, the TRICARE UF utilizes a four-tier formulary system, similar to prescription drug benefit programs offered through commercial health insurance plans. It is the DOD P&T process that assigns a product to a tier for both clinical and cost reasons. The TRICARE UF includes a wide range of both generic and branded drug products. Being assigned to Tier 1, Tier 2, or Tier 3 is foundationally critical for a patient in this healthcare system to access the product. The TRICARE UF also specifies step-through procedures and prior authorization requirements, if they apply. Through the same DOD P&T process, a product may also be placed on the Basic Core Formulary (BCF), which is a subset of the TRICARE UF. The BCF is a list of essential medications generally required for primary care needs and it is these products that are required to be widely available at military pharmacies. The DOD P&T process may also place a product on the Extended Core Formulary (ECF). These products may be stocked at the military pharmacy based on local MTF policy or an identified patient need. Generally, the ECF includes drugs that are specific to a more specialized course of treatment or less common conditions. So, while a product may be included on the TRICARE UF, access to the product may be further smoothed through its additional inclusion on one of the two formulary subsets.
By understanding the TRICARE UF as well as the two subset formularies, a pharmaceutical manufacturer can differently understand the importance of responding to the DOD P&T solicitation regarding class review, utilization management, or newly approved drug agents. Responding to this solicitation, even if not actively engaging directly into this health system, confirms a commitment to product access for the 9.5 million TRICARE beneficiaries.