FACT SHEET PHARMACY OPERATIONS DURING THE COVID-19 PANDEMIC March 3 0 , 20 2 0 Today, the Department issued guidance directing that all Military Medical Treatment Facilities (MTFs) review their current pharmacy programs when considering curtailment of Services to their Beneficiaries. https://Health.mil/COVIDPharmacyguidance In light of the COVID-19 Pandemic and emergency declarations, the Department must take immediate action to ensure the readiness posture of the United States Military. With growing concerns of coronavirus (COVID-19) impacting our communities, pharmacy services in the MTF’s must be diligent in following Centers for Disease Control and Prevention (CDC) guidelines to protect themselves and pharmacy beneficiaries. The DOD remains committed to addressing patient concerns and care, and maintaining our capabilities for the national response – all while maintaining the readiness of our military force. WHY IS THIS ACTION BEING TAKEN? In order to maintain patient and personnel safety, The Department will take actions as prescribed by Health Protection Condition (HPCON) Risk Levels and health official’s guidance and will adjust our pharmacy operations as necessary. The goal is to limit disruptions to service. We must, however, take appropriate safety measures in accordance with risk levels as they are elevated due to COVID-19. Careful local assessments will determine the status of each individual military pharmacy and may result in temporary measures to adapt to this changing situation. In extreme circumstances, there may be temporary, partial or full limitations of Military MTF Pharmacy services. These will be temporary solutions that will be assessed daily. The Department is committed to maintaining the support for our active duty forces, which remains the Department’s top priority. The Defense Health Agency’s focus is to ensure our Military MTF’s align with actions being taken across the nation to conserve vital healthcare resources for expected surges in the COVID-19 public health emergency. WHAT HAPPENS NOW? The Director of the Defense Health Agency is providing guidance to Military MTF Directors when considering diversion of non-Active duty and non- active duty family members to home 2 delivery and retail network pharmacies in a step-wise approach, first displacing beneficiaries that are not enrolled to a MTF and then as conditions at higher levels of HPCON change, to consider displacing by beneficiary category starting with Retirees and their family members. Every MTF Director who has a pharmacy facility within their MTF will receive several documents to educate their specific audiences to include senior mission commander, installation personnel and their beneficiaries. The Military MTF Director will brief the Installation Commander prior to any service degradation. MTF pharmacies will be directed to follow Health Protection Condition (HPCON) Actions which include the following: Promote use of TRICARE Pharmacy Home Delivery and retail network pharmacies Implement virtual appointments for Clinical Pharmacy encounters Strongly encourage PPE for those who are interacting with patients Modifying patient care/waiting areas to promote social distancing Limit waiting rooms to a single point of entry for patients Provide early refills where appropriate Implement plans to accommodate high risk patients (curbside service, designate alternate medication pick up locations, etc.) Implement prescription drop off and pick up only processes Q&A Q1: Will my military pharmacy be closing? Will I be able to get my medications from a military pharmacy? A1: In order to maintain patient and personnel safety amidst COVID-19, we will take actions as prescribed by Health Protection Condition (HPCON) Risk Levels and health official’s guidance and will adjust our Military Medical Treatment Facility (MTF) Pharmacy operations as necessary. Careful local assessments will determine the status of each individual military pharmacy and may result in temporary measures to adapt to this changing situation. In extreme circumstances, there may be temporary, partial or full limitations of MTF Pharmacy services. These will be temporary solutions that will be assessed daily. In the case of a local outbreak or a confirmed case of COVID-19 amongst MTF Pharmacy teammates, MTF Directors have been authorized to limit pharmacy services as necessary. This may include: The introduction of alternative pick up options (staggered pick up times, curbside pickup, etc.). The temporary transfer of non-enrolled, non-Active Duty Service Members (ADSMs) and/or non-Active Duty Family Members to home delivery or retail network pharmacies. The temporary closure of a military pharmacy. We don’t expect any of these limitations to be a routine practice but rather a case-bycase determination based on the severity of the spread of COVID-19 at a specific 3 location. If pharmacy services are limited, they will be assessed daily and reopened as soon as it is safe for personnel and beneficiaries. Q2: How will I know if my military pharmacy is operating? A2: You can call your Military Medical Treatment Facility (MTF) pharmacy refill line to check for changes to service offerings, closures, and resumption of services. This will be your primary information source for military pharmacy operations during this time. The refill line phone number is usually printed on any prescription bottle with refill authorization. You can look up your pharmacy’s number via www.tricare.mil/mtf. Your local public affairs office may also engage local tactics to keep beneficiaries informed. Q3: What should I do if my military pharmacy is closed due to COVID-19? A3: If your pharmacy has a partial or full closure, they will ensure they have staff available to assist in transferring your prescription to mail order or a retail network pharmacy of your choice. There are several actions you can take if your military pharmacy is closed due to COVID-19: Call your Military Medical Treatment Facility (MTF) pharmacy refill line to check for changes to service offerings, closures, and resumption of services: You can look up your pharmacy’s number via www.tricare.mil/mtf Call Express Scripts at 877-363-1303 to speak with a pharmacist 24/7 Switch your prescription to TRICARE Pharmacy Home Delivery by calling Express Scripts at 877-363-1303 or visiting www.militaryrx.express-scripts.com/home-delivery Find a retail network pharmacy via https://militaryrx.express-scripts.com/findpharmacy. Call your retail network pharmacy and ask them to call your MTF to transfer your medication or your provider for a new prescription. If you don't have any refills remaining, call your provider to send a new prescription to either the Express Scripts TRICARE Pharmacy Home Delivery or your network pharmacy Q4: Will I have to pay copayments for my prescriptions at retail network pharmacies and via home delivery? A4: Yes. Copayments are directed by law and the DOD cannot waive them. Visit https://tricare.mil/Costs for an overview of pharmacy copayments. You can search your specific medication(s) and determine your coverage and copayments at www.express-scripts.com/tform. Q5: I am worried about running out of my medications. What should I do? A5: We are encouraging beneficiaries to refill their medications at the appropriate time. Standard refill policies, which allow you to refill or renew a prescription medication when 25% of your current prescription is remaining, should help you stay on track with your medication during this time. We understand the desire to be prepared. Present conditions do not call for us to enact early refills at Home Delivery or retail network pharmacies, but we are monitoring the situation closely and are updating our information and policies as the situation requires. Should you have any questions or concerns about your individual situation, Express Scripts pharmacists are available 24/7 to answer questions, offer counseling and support, and assist with prescription orders. Call Express Scripts at 877-363-1303. Q6: Can the mail order system support an increase in workload from the beneficiary population? A6. Yes, the home delivery network is fully operational and able to absorb a potential increase in the DOD workload. In addition to home delivery, the retail network is currently not experiencing any degradation of services and many retail network pharmacies offer home delivery as well. Q7: Will all military pharmacies reduce services or close? A7. No. The goal is to maintain pharmacy services for all military beneficiaries to the greatest degree possible. Decisions to temporarily reduce or discontinue services at a military pharmacy will be handled on a case by case basis and in coordination with the Military Medical Treatment Facility (MTF) Director, the Installation Commander, and DHA Pharmacy Operations staff. Any reduction in pharmacy services will be monitored daily and restored to full operations as quickly as possible for all beneficiaries. Q8: How will you determine who will transition to home delivery or retail network pharmacies? A8. Based on Health Protection Conditions (HPCON) levels and spread of the pandemic at the particular location, Military Medical Treatment Facility (MTF) Directors have been authorized to limit pharmacy services with a step-wise approach that prioritizes the readiness posture of the United States Military. The following limitations MAY be implemented: First, beneficiaries that are not enrolled to an MTF may be temporarily required to switch to home delivery or a retail network pharmacy due to local COVID-19 impact. If a further reduction in services is required, MTF enrolled Retirees and Retired Family members may be temporarily required to switch to home delivery or a retail network pharmacy due to local COVID-19 impact. Finally, the temporary closure of a local military pharmacy may require all local beneficiaries to switch to home delivery or a retail network pharmacy on a temporary basis. Any reduction in pharmacy services will be coordinated between the MTF Director, the Installation Commander, and Pharmacy Operations. Q9: Will this impact me? A9. The best way to determine if a change in pharmacy services impacts you is to call your local military pharmacy refill call in line to determine the pharmacies operating status. The prescription refill line will be updated routinely with the latest information regarding the operating status of your local Military Medical Treatment Facility (MTF) pharmacy. While we expect limited impact at most military MTF pharmacies, all eligible beneficiaries may be impacted due to the spread of COVID-19. Q10: How will you transfer my prescription if the military pharmacy is closed? A10: The Defense Health Agency has issued guidance to military pharmacies to ensure that solutions including remote capabilities are enabled in case of full pharmacy closures, where staff will be available to assist in transferring your prescription to either mail order or a retail network pharmacy of your choice. Q11: What if I cannot reach my military pharmacy? A11: Express Scripts is the DOD’s pharmacy benefit contractor and supports the DOD in delivering the pharmacy benefit to its 9.5 million beneficiaries. Express Scripts pharmacists are available 24/7 to help answer questions about your prescriptions, to include supporting prescription transfers. You can call Express Scripts anytime at 877- 363-1303. If you are for some reason unable to find a solution with your prescription after speaking with Express Scripts, you may want to call your provider directly and ask them to eprescribe a new prescription to Express Scripts TRICARE Pharmacy Home Delivery or to a retail network pharmacy of your choice. Q12: Will this impact inpatient pharmacy operations? A12: No. Inpatient pharmacy services will be given priority to ensure a full scope of pharmacy care for inpatients. Q13: Will military pharmacies continue to receive medication supplies? A13: Yes. The national pharmacy supply chain is a very robust system and currently there are no forecast long term medication shortages. The Defense Health Agency (DHA) carefully monitors medication supply. The usage for some medications that may be used to treat the symptoms of patients with COVID-19 has increased significantly during this time period. For some medications, the DHA may utilize quantity limits to ensure access and fair distribution of these medications to patients during this period. These issues will be resolved as quickly as possible. Q14: What if I already called in my refill to a military pharmacy and the pharmacy has shut down? Q14: Call the military pharmacy refill call-in line to receive instructions on what to do if you have already called in your prescription to your military pharmacy.