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from Spencerís Benefits Reports: The Department of Defense (DOD) has issued proposed regulations governing double coverage under the TRICARE Pharmacy Benefits Program and the Medicare Part D prescription drug benefit program. The proposed regulations appeared in the Dec. 28, 2006 Federal Register.
TRICARE-eligible beneficiaries who are entitled to Medicare Part A on the basis of age, disability, or end-stage renal disease, maintain their TRICARE eligibility when they are enrolled in the supplementary medical insurance program under Medicare Part B. In general, in the case of medical or dental care provided to these individuals for which payment may be made under both Medicare and TRICARE, Medicare is the primary payer and TRICARE normally will pay the actual out-of-pocket costs incurred by the person.
The proposed regulations would prescribe double coverage payment procedures and make revisions to the existing TRICARE rules to accommodate beneficiaries who are eligible under both Medicare and TRICARE, and who participate in Medicareís outpatient prescription drug program under Medicare Part D. According to the DOD, these revisions are necessary because of the requirements contained in the Centers for Medicare and Medicaid Servicesí (CMS) final regulations for the Medicare Prescription Drug Benefit, Part D Plans with Other Prescription Drug Coverage.
The proposed regulations also would establish requirements and procedures for implementation of the improvements to the TRICARE Pharmacy Benefits Program directed by Sec. 714 of the Ronald W. Reagan National Defense Authorization Act for Fiscal Year 2005 (P.L. 108-365). The regulations would clarify that the cost-sharing requirements for Medicare-eligible beneficiaries may not be in excess of the cost-sharing requirements applicable to other retirees, their dependents, former spouses, and survivors. In addition, the regulations would authorize the DOD Pharmacy and Therapeutics Committee to make a separate and additional determination of the relative clinical and cost-effectiveness of pharmaceutical agents to assure that pharmacies of the uniformed services have on their formularies pharmaceutical agents that provide greater value than other uniform formulary agents in that therapeutic class. Finally, the regulations describe the transition process that will occur as the uniform formulary is developed and uniform service facilities move to a uniform formulary, consistent with their scope of practice.
Comments on the proposed regulations must be submitted by February 26 to the Federal Docket Management System Office, 1160 Defense Pentagon, Washington, DC 20301-1160. For further information, contact Travis Watson at (703) 681-2890, ext. 6707.
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