TREA: The Enlisted Association Blog

TREA "The Enlisted Association" Washington Update

• • TRICARE Co-pays and Push for MTF to serve Active Duty Only

TREA "The Enlisted Association" Washington Update

TRICARE Co-pays and Push for MTF to serve Active Duty Only

TREA Members
Do you use DOD services at Military Treatment Facilities?
Do you get prescription drugs via TRICARE?
If so, your access to services and benefits may be changing.

In response to the current COVID-19 outbreak, military treatment facilities (MTF's) and pharmacies under the Military Health System have changed and limited access to the services available to non-active duty service members, their families, and retired beneficiaries. Military commanders of MTF's were directed to make local assessments and determine the standard operating procedures of each military pharmacy.

In the instance of a local outbreak or a confirmed case of COVID-19 at a military MTF pharmacy, MTF commanders have been authorized to limit pharmacy services as necessary; which may include:

1. Alternative pickup options;
2. The temporary transfer of non-enrolled, non-active duty service members (ADSMs) and/or non-active duty family members to home delivery or retail; and
3. The temporary closure of a military pharmacy.

For beneficiaries who normally receive care at an MTF, access to necessary prescription medications comes at no cost out of pocket. However, for those who now have no way of accessing an MTF, many have either resorted to receiving their medication through TRICARE mail-order or by traveling to their local pharmacy; both options, require the beneficiary to pay for their medication out-of-pocket. 

While TREA recognizes that MTF commanders have been placed in a difficult position to ensure the health, safety, and security of patients and staff, beneficiaries who have been forced to pay for their medication out-of-pocket are now exposed to an unanticipated financial burden that would not normally be faced if not for the spread of COVID-19.

As TREA continues to negotiate further legislation in response to the COVID-19 pandemic, we urge you to write your elected officials advocating for the temporary elimination of co-pays issued following participation in the TRICARE Pharmacy Home Delivery program.

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Part two -- TREA Members
DOD plans to have MTFs serve only active duty members

Currently, the Military Healthcare System (MHS) is undergoing a transformation driven by the overarching objective to "improve the readiness of our forces and the health care provided to warfighters, retirees, and their families." With the enactment of the FY2017 National Defense Authorization Act (NDAA), Congress directed the Department of Defense (DOD) to realign the capabilities of medical treatment facilities (MTF's) nationwide to support readiness "generation and sustainment."

The Defense Health Agency (DHA) has been tasked with exercising authority, direction, and control of MTF's nationwide using what is referred to as a "market construct management model." This market concept strives to drive process standardization across the services, reduce "undesired variability", and increase efficiencies across the MHS at-large. In application, it is the wishes of Congress, DOD, and DHA, that these market organizations will provide shared administrative services to the hospitals and care clinics in their respective regions.

Current Status:
From a DOD report released prior to the COVID 19 crisis, it appears as if structural changes to 50 MTF's nationwide are going to push approximately 200,000 military members out of MTF's and into the TRICARE civilian network. As a result, active-duty family members, retirees, and their families who currently receive care at MTF's are going to have to find new, civilian primary care managers in their communities. These changes come with massive implications that unfortunately come with many unanswerable questions. 

Unfortunately, what TREA does know is that the local markets already exposed to MTF downsizing have been unable to absorb the sharp spikes in demand within their local networks. As a result, beneficiaries have been turned away from local community care providers at some facilities or primary care provider's (PCP's) are not accepting TRICARE patients.

In addition, there exists the concern that local community care providers WILL NOT be willing to accept TRICARE MTF beneficiaries at current reimbursement rates. As a result, impacted beneficiaries may face an increase in out-of-pocket costs via co-pays, ranging from $20 for primary care visits to $62 for emergency room services. DOD DID NOT disclose an implementation plan. 

What happens next:
TREA remains committed to improving the quality of and accessibility to hard-earned military health care benefits. There are many concerns leading to questions for Congress, DHA, and DOD.

TREA knows it is essential and will continue to:

1. Demand transparency from DOD, DHA, and Congress on access to care and other elements of the patient experience at MTF's or in their civilian TRICARE networks;
2. Advocate to roll back certain copay increases for mental health visits, pharmaceuticals, and primary care appointments;
3. Ensure there are NO GAPS in case management;
4. Hold DOD accountable on the promise to reassess plans if, as the changes are phased in, local civilian facilities near an affected MTF are unable to "provide adequate access to care;"

TREA Members -- What you can do:  

1. Keep the TREA team in the loop if you experience problems after transitioning from your MTF to the TRICARE civilian network. Please contact legislativeinfo@trea.org.
2. Write your Senator and or Congressman if you experience problems after transitioning from your MTF to the TRICARE civilian network.