S.Amdt. 3255

1. Adds SEC. 704. COST-SHARING RATES FOR THE PHARMACY BENEFITS PROGRAM OF THE TRICARE PROGRAM at the end of subtitle A of title VII

   Adds a section

   In S. 3254 · Placed on Calendar Senate

   Section 717(a)(1) of the National Defense Authorization Act for Fiscal Year 1996 (Public Law 106-104; 110 Stat. 376; 10 U.S.C. 1073 note) is amended by striking "military retirees" and inserting "members of the Armed Forces (whether in the regular or reserve components) and their dependents, military retirees and their dependents, dependent children under the age of 21, and dependents of members on active duty with severe disabilities and chronic health care needs".

   Inserted: SEC. 704. COST-SHARING RATES FOR THE PHARMACY BENEFITS PROGRAM OF THE TRICARE PROGRAM.

   Inserted: (a) In General.--Section 1074g(a)(6) of title 10, United States Code, is amended--

   Inserted: (1) by striking subparagraph (A) and inserting the following new sub paragraph (A):

   Inserted: "(A) The Secretary, in the regulations prescribed under subsection (h), shall establish cost-sharing requirements under the pharmacy benefits program. In accordance with subparagraph (C), such cost-sharing requirements shall consist of the following:

   Inserted: "(i) With respect to each supply of a prescription covering not more than 30 days that is obtained by a covered beneficiary under the TRICARE retail pharmacy program--

   Inserted: "(I) in the case of generic agents, $5;

   Inserted: "(II) in the case of formulary agents, $17; and

   Inserted: "(III) in the case of nonformulary agents, $44.

   Inserted: "(ii) With respect to each supply of a prescription covering not more than 90 days that is obtained by a covered beneficiary under the national mail-order pharmacy program--

   Inserted: "(I) in the case of generic agents, $0;

   Inserted: "(II) in the case of formulary agents, $13; and

   Inserted: "(III) in the case of nonformulary agents, $43."; and

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   Inserted: (2) by adding at the end the following new subparagraph:

   Inserted: "(C)(i) Beginning October 1, 2013, the amount of any increase in a cost-sharing amount specified in subparagraph (A) in a year may not exceed the amount equal to the percentage of such cost-sharing amount at the time of such increase equal to the percentage by which retired pay is increased under section 1401a of this title in that year.

   Inserted: "(ii) If the amount of the increase otherwise provided for a year by clause (i) is less than $1, the increase shall not be made for such year, but shall be carried over to, and accumulated with, the amount of the increase for the subsequent year or years and

   Inserted: made when the aggregate amount of increases carried over under this clause for a year is $1 or more.

   Inserted: "(iii) The provisions of this subparagraph shall not apply to any increase in cost-sharing amounts described in clause (i) that is made by the Secretary of Defense on or after October 1, 2022. The Secretary may increase copayments, as considered appropriate by the Secretary, beginning on October 1, 2022.".

   Inserted: (b) Effective Date.--

   Inserted: (1) In general.--The cost-sharing requirements under subparagraph (A) of section 1074g(a)(6) of title 10, United States Code (as amended by subsection (a)(1)), shall apply with respect to prescriptions obtained under the TRICARE pharmacy benefits program on or after such date as the Secretary of Defense shall specify, but not later than the date that is 45 days after the date of the enactment of this Act.

   Inserted: (2) Federal register.--The Secretary shall publish notice of the effective date of the cost-sharing requirements specified under paragraph (1) in the Federal Register.

   Inserted: SEC. 705. PILOT PROGRAM ON REFILLS OF MAINTENANCE MEDICATIONS THROUGH THE TRICARE MAIL-ORDER PHARMACY PROGRAM.

   Inserted: (a) In General.--The Secretary of Defense shall conduct a pilot program to refill prescription maintenance medications for each TRICARE for Life beneficiary through the national mail-order pharmacy program under section 1074g(a)(2)(E)(iii) of title 10, United States Code.

   Inserted: (b) Medications Covered.--

   Inserted: (1) Determination.--The Secretary shall determine the prescription maintenance medications included in the pilot program under subsection (a).

   Inserted: (2) Supply.--In carrying out the pilot program, the Secretary shall ensure that the medications included in the program--

   Inserted: (A) are--

   Inserted: (i) generally available through retail pharmacies for an initial filling of a 30-day or less supply; and

   Inserted: (ii) obtained by refill through the national mail order pharmacy program; or

   Inserted: (B) are both available for an initial filling or obtained by refill at a military medical treatment facility.

   Inserted: (3) No denial.--In the instance when a refill of such maintenance medication is not obtained through a national mail-order pharmacy program, the Secretary shall ensure that beneficiaries are provided a supply at a retail pharmacy for a limited period of time. The Secretary may impose a cost-sharing requirement on beneficiaries accessing such supply.

   Inserted: (4) Exemption.--The Secretary may exempt the following prescription maintenance medications from the requirements in paragraph (2):

   Inserted: (A) Medications for acute care needs.

   Inserted: (B) Medications dispensed to patients in long-term care facilities.

   Inserted: (C) Such other medications as the Secretary considers appropriate.

   Inserted: (c) Nonparticipation.--

   Inserted: (1) Opt out.--The Secretary shall give beneficiaries who have been covered by the pilot program under subsection (a) for a period of at least one year an opportunity to opt out of continuing to participate in the pilot program.

   Inserted: (2) Waiver.--The Secretary may waive the requirement for a beneficiary to participate in the pilot program if the Secretary determines, on an individual basis, that the waiver is appropriate.

   Inserted: (e) Reports.--Not later than March 31 of each year beginning in 2014 and ending in 2018, the Secretary shall submit to the congressional defense committees a report on the pilot program under subsection (a), including the effects of offering incentives for the use of mail-order pharmacies by TRICARE for Life beneficiaries, access to maintenance medications, and the effect on retail pharmacies.

   Inserted: (f) TRICARE for Life Beneficiary Defined.--In this section, the term "TRICARE for Life beneficiary" means a beneficiary under the TRICARE program who is enrolled in the Medicare wraparound coverage option of the TRICARE program made available to the beneficiary by reason of section 1086(d) of title 10, United States Code.

   Inserted: (g) Sunset.--The Secretary may not carry out the pilot program under subsection (a) after December 31, 2017.

   Original wording

   At the end of subtitle A of title VII, add the following:

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As printed