Quantity Limits for Prescriptions of Albuterol and Levalbuterol Inhalers 8 April, 2020 BACKGROUND : Albuterol and levalbuterol inhalers are used to treat breathing problems including asthma. These medications have recently been publicized as useful treatment options for COVID-19. Albuterol inhaler dispensing volumes have significantly increased over the past month by nearly 100% at all points of service: military pharmacy, retail network, and TRICARE Pharmacy Home Delivery Industry and logistics partners including the Defense Logistics Agency (DLA) have reported that the increased utilization will impact supply and result in shortages unless quantity limits are put in place to evenly distribute medications over time to both chronic and acute patients. BLUF : On 10 April 2020, the Defense Health Agency (DHA) will enact Quantity Limits (QL) of one inhaler per prescription for albuterol and levalbuterol inhalers. These medications have experienced significant increased use due to the COVID-19 Pandemic. Through engaging Quantity Limits, the DHA will manage available supply to ensure that patients with asthma and other conditions continue to have access to these medications to manage their health and readiness while the inhalers are simultaneously utilized in treating COVID-19. KEY MESSAGES: Due to nearly a 100% increase of Albuterol and levalbuterol inhaler dispensing volumes over the past month, the DHA will implement temporary quantity limits for prescription refills at all points of service: military pharmacy, retail network, and TRICARE Pharmacy Home Delivery. Temporary quantity limits on Albuterol and levalbuterol inhalers will ensure all TRICARE beneficiaries will be able to obtain sufficient inhalers to treat breathing problems including asthma, as well as when prescribed to treat the symptoms of COVID19. There is no anticipated shortage of Albuterol and levalbuterol inhalers, however due to the increased demand, the temporary quantity limits of 1 inhaler per prescription refill will ensure no such shortage will exist. Any patient in need of additional inhalers during this period of quantity refill limits will be authorized additional inhalers by contacting their provider, via counter front request or by calling ESI. Quantity limit policy will be evaluated end of April and will be lifted as soon as it is clear TRICARE will not likely experience any shortages in the supply of inhalers. With a prescription, one inhaler will be provided for each prescription filled. This limit of 1 inhaler per prescription applies at military pharmacies, retail network pharmacies, and via TRICARE Pharmacy Home Delivery. When a patient needs another inhaler because their inhaler is running low, they can request a refill from their pharmacy. Copayments are mandated by law and full copayments will be applied to each fill (which, under the current, temporary quantity limits, is one inhaler). Depending on the type of albuterol or levalbuterol inhaler, patients may pay $10 (home delivery) or $13 (retail network pharmacy) for one fill of a generic inhaler, $29 or $33 for one fill of a name-brand inhaler, or $60 for one fill of a non-formulary inhaler. Please check the TRICARE Formulary Search tool at www.express-scripts.com/tform for more information on the category and cost of your medication. The DHA only will only temporarily enact quantity limits on albuterol and levalbuterol inhalers to ensure the supply is available to every patient that needs it. We expect the demand for inhalers to level out or decline as states across the country flatten the curve of COVID-19 infections. The intent of this quantity limit is to help to ensure supply is maintained for all beneficiaries. We will monitor conditions on a daily basis and update quantity limit restrictions as appropriate at the end of April 2020.