Sec. 702. Revisions to cost-sharing requirements for TRICARE for Life and the Pharmacy Benefits Program
1,098 words·~5 min read·
/bill/114/s/1118/is/section-702A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Section 1086(d)(3) of title 10, United States Code, is amended— by redesignating subparagraph
(C)as subparagraph (D); and by inserting after subparagraph
(B)the following new subparagraph (C): A person described in paragraph
(2)(except as provided in clauses
(vi)and (vii)) shall be required to pay an annual enrollment fee as a condition of eligibility for health care benefits under this section. Such enrollment fee shall be an amount (rounded to the nearest dollar) equal to the applicable percentage (specified in clause (ii)) of the annual retired pay of the member or former member upon whom the covered beneficiary's eligibility is based, except that the amount of such enrollment fee shall not be in excess of the applicable maximum enrollment fee (specified in clause (iii)). In the case of enrollment for a period less than a full calendar year, the enrollment fee shall be a pro-rated amount of the full-year enrollment fee. The applicable percentage of retired pay shall be determined in accordance with the following table: For: The applicable percentage for a family group of two or more persons is: The applicable percentage for an individual is: 2016 0.50% 0.25% 2017 1.00% 0.50% 2018 1.50% 0.75% 2019 and after 2.00% 1.00%. For any year 2016 through 2019, the applicable maximum enrollment fee for a family group of two or more persons shall be determined in accordance with the following table: For: The applicable maximum enrollment fee for a family group whose eligibility is based upon a member or former member of retired grade O–7 or above is: The applicable maximum enrollment fee for a family group whose eligibility is based upon a member or former member of retired grade O–6 or below is: 2016 $200 $150 2017 $400 $300 2018 $600 $450 2019 $800 $600. For any year after 2019, the applicable maximum enrollment fee shall be equal to the maximum enrollment fee for the previous year increased by the percentage by which retired pay is increased under section 1401a(b)(2) of this title for such year. The applicable maximum enrollment fee for an individual shall be one-half the corresponding maximum fee for a family group of two or more persons (as determined under clauses
(iii)and (iv)). Clause
(i)does not apply to— a dependent of a member of the uniformed services who dies while on active duty; a member retired under chapter 61 of this title; or a dependent of such a member. Clause
(i)does not apply to a person who, before January 1, 2016, met the conditions described in paragraphs
(A)and (B). . Subparagraph
(C)of section 1086(d)(3) of title 10, United States Code, as added by paragraph (1), shall take effect on January 1, 2016. Paragraph
(6)of section 1074g(a) of such title is amended to read as follows: In the case of any of the calendar years 2016 through 2024 the cost sharing referred to in paragraph
(5)shall be payment by an eligible covered beneficiary of amounts determined in accordance with the following table: For: The cost sharing amount for a 30-day supply of a retail generic is: The cost sharing amount for a 30-day supply of a retail formulary is: The cost sharing amount for a 90-day supply of a mail order generic is: The cost sharing amount for a 90-day supply of a mail order formulary is: The cost amount for a 90-day supply of a mail order non-formulary is: 2016 $8 $28 $0 $28 $54 2017 $8 $30 $0 $30 $58 2018 $8 $32 $0 $32 $62 2019 $9 $34 $9 $34 $66 2020 $10 $36 $10 $36 $70 2021 $11 $38 $11 $38 $75 2022 $12 $40 $12 $40 $80 2023 $13 $43 $13 $43 $85 2024 $14 $45 $14 $45 $90. For any year after 2024, the cost sharing referred to in paragraph
(5)shall be payment by an eligible covered beneficiary of amounts equal to the cost-sharing amounts for the previous year, adjusted by an amount, if any, as determined by the Secretary to reflect changes in the costs of pharmaceutical agents and prescription dispensing, rounded to the nearest dollar. Notwithstanding subparagraphs
(A)and (B), the cost-sharing amounts referred to in paragraph
(5)for any year after 2015 shall be the cost-sharing amounts, if any, under this section as of January 1, 2015, in the case of— a dependent of a member of the uniformed services who dies while on active duty; a member retired under chapter 61 of this title; or a dependent of such a member. . Section 1116 of such title is amended— in subsection (a)(1), by striking subsection (c), which and inserting subsection (c)(1), which (together with any amount paid into the Fund under subsection (c)(4)) ; and in subsection (c)— by striking The Secretary and inserting
(1)Except as provided in paragraph (2), the Secretary ; and by adding at the end the following new paragraphs: If for any fiscal year the Secretary of Defense determines at the beginning of that fiscal year that the amount that would otherwise be required to be certified under paragraph
(1)for that fiscal year would not be accurate if there were to be enacted during the current session of Congress a significant change in law requested in the Budget of the President for that fiscal year that upon enactment would reduce the amount otherwise required to be certified under paragraph
(1)for that fiscal year, the Secretary may certify to the Secretary of the Treasury under paragraph
(1)a reduced amount for that fiscal year taking into consideration the amount of the reduction for that fiscal year that would occur upon enactment of such change in law. Not later than 120 days after the beginning of a fiscal year for which a certification under paragraph
(1)is submitted pursuant to paragraph (2), the Secretary of Defense— shall notify the Secretary of the Treasury whether since the beginning of the fiscal year a significant change in law has been enacted which if in effect at the beginning of the fiscal year would have resulted in a revised amount certified under paragraph
(1)without regard to paragraph (2); and based upon any such change in law since the beginning of the fiscal year, shall certify a final amount for the fiscal year. If a final amount certified under paragraph
(3)for any fiscal year is greater than the amount certified pursuant to paragraph
(2)for that fiscal year, the Secretary of the Treasury shall promptly pay into the Fund from the General Fund of the Treasury the difference between those amounts. .