National Defense Authorization Act for Fiscal Year 2018

Floor Speech

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Mr. President, as the Senate considers the National Defense Authorization Act, or the NDAA, I rise today to discuss a simple amendment in support of my constituents in South Dakota who are military retirees, as well as those in many other States who find themselves in a similar circumstance.

These retirees may be disproportionately and unfairly impacted by increases in the TRICARE prescription drug copay increases that we find within the bill that we are considering today. Specifically, provisions in this bill will increase cost-sharing amounts for the TRICARE pharmacy benefits program for the years 2018 through the year 2026.

Now, the rationale for the increases in the bill that we are considering today are that the savings generated from pharmaceutical cost-share increases can be used to improve healthcare outcomes and the experience of care for beneficiaries in the military health system, and I support that. I believe in improving the care for beneficiaries in the military health system. But in this particular case, the increased TRICARE pharmacy copays must be carefully considered to make certain that they could not disproportionately impact one part of the beneficiary population.

Unfortunately, that would be the case for South Dakota and for other largely rural States with large military retiree populations that live too far away from military treatment facilities to easily travel to these facilities and to make themselves available for the prescriptions that are available at those facilities. Instead, these military retirees and their families are compelled to use the TRICARE mail order system or the retail pharmacies in their local communities and, in both cases, they would have to pay higher copays. In other words, if you live close to the facility, you can go to the facility and receive those medicines, those pharmaceuticals. But if you are farther away and you have to use a retail shop in your own community or use mail order, you would be subject, under this bill, to a higher copay cost.

For example, a copay for a generic drug ordered through the TRICARE mail order system will increase by $10 in fiscal year 2018. Now, while this does not seem like a lot of money, those costs can add up rapidly if a military retiree or his family is required to make multiple copays for multiple prescriptions. Simply put, our military retirees who live more than 40 miles away from a military treatment facility should not be unfairly forced to pay higher copays on prescription drugs just because of where they choose to live.

Under my amendment, we would take a step back. The amendment would freeze copay increases for TRICARE retirees and their families who live more than 40 miles from a military treatment facility. Additionally, the amendment would require the Department of Defense to actually assess the financial impact of the higher copays on these beneficiaries.

Now, the 40-mile figure that I have chosen was not done without some thought. I think we were careful in how we chose the 40-mile figure. Forty miles is the distance used by both the Department of Defense and the Department of Veterans Affairs as a boundary for reasonable access to a healthcare facility. The Department of Defense TRICARE Prime program, in which care is primarily delivered through a military treatment facility, is available to individuals who reside within prime service areas, or PSAs. PSAs are locations that are within 40 miles of a military treatment facility.

Similarly, the VA Choice Program, which allows veterans access to healthcare in local communities rather than waiting for a VA appointment or traveling to a VA facility, is available to those whose residence is more than 40 miles driving distance from the closest VA medical facility.

My amendment would also set a deadline of 60 days after the enactment of this legislation for the Department of Defense to report on the financial impact of the copay increases on military retirees and their families.

With the information provided by the Department of Defense, Congress can then rationally assess the impact of the copay increases on beneficiaries who live distant from military treatment facilities and incorporate appropriate provisions in future legislation.

I appreciate the opportunity to discuss my amendment, which would rectify this unintended effect to military retirees and their families who live in rural parts of our country.

Thank you, Mr. President.

I yield the floor.

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