AF pharmacies implement new formulary guidelines

  • Published
  • By Lt. Col. David W. Bobb
  • Air Force Medical Service
WASHINGTON (AFPN) --  Air Force pharmacies will no longer distribute some high-use, but expensive medications. This was outlined in a memorandum recently sent out to all Air Force pharmacies by Maj. Gen. (Dr.) Joseph E. Kelley, assistant surgeon general for health-care operations.

“It’s no secret that (fiscal 2004) has been an extremely challenging budget year for the Air Force Medical Service,” General Kelley said in the memo. “In addition to being faced with more expensive drugs coming to market this year, there has been an 8 percent price increase in the approximately 150 high-use medications contained on the (Department of Defense and Veterans Affairs) contract list.”

To assist in meeting the medical service fiscal parameters, changes will be made in dispensing nonsedating antihistamines, some arthritis medications and insulin.

General Kelley said he believes the implementation of these formulary guidelines present sound clinical options with a very minimal impact of patient care.

For patients requesting refills on the medications being deleted, a 30-day supply will be provided to allow them enough time to obtain a new prescription for another medication.

“At times, it can be a somewhat bewildering process to track what medications your military treatment facility pharmacy keeps in stock,” said Col. Phil L. Samples, pharmacy consultant to the surgeon general.

“Not only can this be confusing at the local level, but as families (move) from base to base, situations arise where one pharmacy may carry a certain medication that another does not based on the scope of practice at any given facility,” Colonel Samples said.

“One of the functions of the DOD Pharmacy and Therapeutics Committee and this policy letter is to minimize these variations,” he said.

To demystify the processes involved in determining which medications are available at a base pharmacy, Colonel Samples said one must look at the total selection process. Currently, there are essentially three systems in place that influence the drug-selection process.

“First, DOD has a (committee comprising) physicians and pharmacists from all services that reviews classes of drugs and makes recommendations regarding individual medications that must be carried at every military pharmacy,” Colonel Samples said. “These medications, called basic core formulary drugs, provide the foundation for all other formulary decisions and represent the minimum number of drugs a pharmacy will carry.

"The intent of this body is to ensure certain maintenance medications for things like blood pressure or diabetes are available throughout the DOD system," he said.

“Next, every (medical facility) has its own pharmacy and therapeutics committee, consisting of local physicians and pharmacists, that evaluates medications for addition to the formulary based upon the scope of practice at that particular facility,” Colonel Samples said. “These medications are then available to augment those on the basic core formulary.”

The third is the Air Force medical operations function itself. This is a relatively new process where officials can direct changes across all Air Force pharmacies.

“The two advantages of this new process are that a medication can now be mandated for inclusion at all Air Force pharmacies thus standardizing the benefit, and (Air Force-wide) savings and cost containment can be realized throughout the system,” Colonel Samples said.

For patients seeking medications not contained on the pharmacy formulary, two options exist, he said.

“First, the Tricare mail-order pharmacy will mail up to a three-month supply of medication directly to the patient’s home for a small co-pay -- $3 or $9 depending on generic or brand-name medication. Second, the (retail) managed care support contract pharmacies provide up to a 30-day supply of medication for a $3 or $9 co-pay,” Colonel Samples said.

“Both of these options provide a broader range of medications than normally found at the MTF pharmacy," he said. "When you consider the combination of the MTF pharmacy, Tricare mail-order pharmacy and retail network pharmacies, patients are ensured they can receive a wide variety of medications."

Patients who have questions regarding their pharmacy benefit can contact their local pharmacy.