When speaking about the healthcare system under the Department of Defense (DOD), many individuals erroneously use the terms Defense Health Agency (DHA), Military Health System (MHS), and TRICARE interchangeably. Each program plays a distinct but synergistic role within this market and it is important for a pharmaceutical or medical device manufacturer to understand the function and purview of each.
The DHA is the central governing entity responsible for providing high quality healthcare to military personnel and their families. The DHA is responsible for providing strategic direction, resource allocation, and policy guidance as well as a unified framework for healthcare delivery across the DOD. The DHA is also responsible for managing the Department of Defense (DOD) Pharmacy and Therapeutics (P&T) Committee, through which all pharmaceutical products are reviewed for placement on the TRICARE Formulary.
The MHS is a federated system comprised of three otherwise autonomous military health units. It includes the Army Medical Command, the Air Force Medical Service, and the Navy Bureau of Medicine and Surgery. Often, a degree of standardization is sought between these entities; however, this looser structure ultimately allows each to meet the unique challenges faced by its patient population. The MHS is subject to the management, decisions, and policies of the DHA. Because the MHS is responsible for delivering the day-to-day patient care, Military Treatment Facilities (MTFs), to include hospitals and clinics, and healthcare professionals, such as military and civilian doctors, fall under its area of responsibility. The MHS provides operational data, which informs policy decisions as well as resource allocations, to the DHA.
TRICARE is a healthcare program somewhat similar to a commercial health insurance program in that it provides comprehensive healthcare coverage to its beneficiaries. TRICARE is the programmatic name that represents over eight core health care delivery plan options with their own name. It is managed by the DHA and accepted a MHS healthcare facilities. Much like a commercial health insurance, TRICARE has drug formulary with tiers and associated co-pays.
Example: Naval Medical Center Portsmouth is subject to the policy decision of DHA because operates as part of the Navy Bureau of Medicine and Surgery (BUMED) under the MHS. Patients have a TRICARE health plan and use the TRICARE Formulary to understand a medication’s associated tier placement and the co-pay level. |
Understanding the hierarchical structure and functional distinctions between DHA, MHS, and TRICARE allow stakeholders to more effectively navigate the DOD healthcare landscape with accuracy and efficiency.