Greater access for TRICARE beneficiaries at lower costs is a win for the warfighter, veterans, their families, DoD and the U.S. taxpayer.
On May 28, the Defense Health Agency announced that upcoming meeting dates and related documents for the Uniform Formulary Beneficiary Advisory Panel (BAP) should be posted soon. This is good news for the healthcare of members of the United States military and their beneficiaries, as well as the American taxpayer.
The Defense Department’s TRICARE Pharmacy Benefits Uniform Formulary provides for the availability of pharmaceutical agents in the complete range of therapeutic classes administered under the Pharmacy Benefit for active duty and retired service members and their families. The selection for inclusion on the Uniform Formulary of pharmaceutical agents in each therapeutic class is based on the relative clinical and cost effectiveness of the agents in such classes. The Military Health Service’s (MHS’s) Pharmacy & Therapeutics Committee (PTC) is responsible for assessing the clinical and cost effectiveness of a pharmaceutical agent and recommending whether a drug is Tier 2 and placed on the Uniform Formulary, or Tier 3 (non-formulary), meaning the drug is not available at medical facilities or retail outlets absent a valid medical necessity and usually at a higher co-pay. PTC members have expertise in treating patients in the DoD healthcare system. After the PTC review of a drug, the next step in the process is review of the PTC findings and recommendations by the BAP. The BAP is made up of representatives from non-governmental organizations and associations representing beneficiaries, and the contractors who administer the TRICARE program. The BAP provides advice and commentary on the PTC’s recommendations with respect to the Uniform Formulary. The DHA director makes final decisions regarding the Uniform Formulary after considering the BAP’s comments on the PTC’s recommendations.
The BAP will now be able to hold public meetings to consider and comment on a series of findings of the PTC since February 2025 covering approximately 300 new drugs. This is good news because once BAP completes its review, the DHA director will be able to make final decisions on including the subject drugs on the TRICARE formulary. The result will be increased access to cost-effective treatments for members of the U.S. military and their beneficiaries. It also will result in lower costs for DoD as proposed drug pricing discounts are based in part on a drug’s inclusion on the formulary (Tier 2). Greater access for TRICARE beneficiaries at lower costs is a win for the warfighter, veterans, their families, DoD and the U.S. taxpayer. Moreover, the dynamic of the PTC and BAP filling their respective roles encourages further future competition and access to new pharmaceutical treatments from the commercial market.
In sum, the announcement that the BAP process is moving forward is a positive step in the right direction. The pharmaceutical industry eagerly awaits further information on the BAP meeting(s) and the current PTC recommendations with respect to the Uniform Formulary. The result of this effort will be greater transparency in decision making (especially for beneficiaries) supporting clinically driven and cost-effective treatments/outcomes for active duty and retired service members and their families.
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Roger Waldron is president of The Coalition for Common Sense in Government Procurement.
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