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'Huge' Tricare savings expected from higher drug co-pays
Stars and Stripes ^ | Feb 23, 2012 | TOM PHILPOTT

Posted on 02/23/2012 6:30:57 PM PST by Jet Jaguar

The biggest knife for slicing Tricare costs off future defense budgets is not new and higher enrollment fees or deductibles proposed for retirees and their families who use one of the military’s health insurance options of Tricare Prime, Standard, Extra or, for the elderly, Tricare for Life.

Those phased increases, as detailed here last week, would save a total of $23 billion over 10 years, mostly by sticking retirees with higher costs.

But even more dollars — $28 billion over 10 years — would be saved in Tricare pharmacy costs alone under a separate proposed plan to revise co-payments for prescriptions filled at retail outlets and through mail order.

These changes might be more palatable to beneficiaries because a lot of the drug dollars saved would come out of the pockets of drug manufacturers and retailers. Beneficiaries still would be hit but the hardest impact would be felt by those unable or unwilling to shift their prescriptions from retail outlets to the more efficient choice of mail order, or to base pharmacies where drugs will continue to be dispensed free of charge.

“Driving [them] to the lowest cost-point venues – military pharmacies and home delivery – and increasing their use of generic drugs are the two overarching goals” of revising the co-payment structure, explained Rear Adm. Thomas J. McGinnis, chief of pharmaceutical operations for Tricare.

Congress must pass legislation to raise Tricare enrollment fees and deductibles under Tricare insurance plans. But Defense officials already have authority to raise drug co-pays in the retail network and at mail order. Lawmakers only need to get out of the way, as they did last year, when the first modest changes occurred to co-pays at retail and mail order in 10 years.

McGinnis said Congress didn’t interfere most likely because the Oct. 1 co-pay changes included removing a $3 charge on generic drugs at mail order. Military associations had lobbied for that for several years, McGinnis said, so their protests were muted on raising co-pays at retail from $3 to $5 for generic drugs, and from $9 to $12 for brand name drugs.

Unless Congress intervenes this year, however, co-pay increases for brand name drugs at retail will not be modest this October. Retirees, their families and active duty family members would begin paying $26 per drug for brand names at their local pharmacies, up from $12. The co-pay thereafter would climb by $2 more each year until reaching $34 in October 2016. After that, co-pays would be adjusted yearly based on overall medical inflation.

Co-pays for brand name drugs at mail order also would jump to $26 from $9, for a 90-day supply, and then climb slowly to $34 by October 2016.

The intent, said McGinnis, is “to gradually increase these co-pays to a more realistic level” after a decade of no change before last year’s increases. Through the war years, drug expenditures rose dramatically at retail outlets, the most costly venue for Tricare. In 2002, prescriptions filled at retail cost $1.28 billion, less than half of annual drug expenditures of $3 billion. By 2009, retail drug costs for Tricare had almost quadrupled, to $4.76 billion, equally to two thirds of total annual pharmacy cost of $7.24 billion.

The cost to Tricare for brand name medications filled at retail is 27 percent higher, on average, than the same prescriptions filled on base or through mail order. The average cost to Tricare for a year’s worth of a brand name medication at retail is $1156 versus $840 through mail order. If generic drugs are substituted, the average falls to $200 a year, whether the drug is dispensed at retail, through mail order or base pharmacies.

Raising co-pays is effective, McGinnis explained. After the modest co-pay hikes drugs at retail last fall, and after generic drugs became free at mail order, “we saw significant shift to home delivery,” said the pharmacy chief.

The switch is most appropriate for patients on maintenance medications such as cholesterol-lowering drugs, blood pressure pills and proton pump inhibitors to prevent gastric reflux. And McGinnis predicts “huge savings” if the department can move beyond modest co-pay increases.

Rep. Joe Wilson (R-S.C.), chairman of the armed services personnel subcommittee, told me he will oppose any plan to raise Tricare drug co-pays, regardless of projected savings in shifting away from retail outlets.

“My view is persons need these pharmaceuticals and they should be convenient. And what’s convenient is to go to a neighborhood pharmacy,” Wilson said. “So I don’t want to discourage that any more than has been.”

“There is also a security issue, which I think is real, with regard to mail order,” Wilson added. “People in some areas feel their mail could be intercepted. That’s not everybody, obviously. But they have a legitimate concern that pharmaceuticals by mail could be stolen.”

Also opposing these changes for their members who stand to lose a lot business are the National Association of Chain Drug Stores and the National Community Pharmacists Association. In a joint press release, however, their complaints focused on limiting “pharmacy choice” for military beneficiaries and losing the special services only neighborhood pharmacists can provide.

Military association aren’t pleased either. A major disappointment for them is that Tricare plans to end cost-free generics at mail order by October 2016. A 90-day supply of generic drugs would cost $9, which by then would match the co-pay for a 30-day supply of generic drugs at retail.

“What’s driving that rationale, to have zero co-pay for mail order generic drugs for the next few years and then it jumps to $9? Why $9,” asked Joseph Barnes, national executive director of the Fleet Reserve Association. “We’ve been advocating eliminating co-pays as an incentive for using what’s now called home delivery. So this is a fairly drastic change.”

Asked about this, Tricare officials released a statement to explain their intention to reset a co-payment on mail-order generic drugs by 2016. The $9 will still be 66 percent cheaper than at retail because mail order prescriptions are for 90 days, they said, and it still will be “a great deal compared to other government insurance plans.” Also, the added revenue “from all co-pay increases is needed to make budget projections.”


TOPICS: VetsCoR
KEYWORDS:

1 posted on 02/23/2012 6:31:00 PM PST by Jet Jaguar
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To: KitJ; T Minus Four; xzins; CMS; The Sailor; ab01; txradioguy; Jet Jaguar; Defender2; ...

Active duty/Retiree Ping.


2 posted on 02/23/2012 6:32:23 PM PST by Jet Jaguar (Romney=Gun Grabber.)
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To: Jet Jaguar

Dang...


3 posted on 02/23/2012 6:36:25 PM PST by Squantos (Be polite. Be professional. But have a plan to kill everyone you meet)
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To: Jet Jaguar
My view is persons need these pharmaceuticals and they should be convenient. And what’s convenient is to go to a neighborhood pharmacy,

I'm on a Medco plan, and nothing is as convenient as clicking a box on a website and taking the pills out of my mailbox a few days later. My Dr. sends the scrips via the internet to Medco, I approve the payment via their website, and they ship. That's for the chronic illness stuff I take every day. If I need a short termer, I can get it at WalMart or wherever.

4 posted on 02/23/2012 6:45:53 PM PST by nascarnation (DEFEAT BARAQ 2012 DEPORT BARAQ 2013)
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To: Jet Jaguar
In the normal course of events, if an institution decides to "raise prices" they do not declare that they are "saving money".

But I guess government is just different ...

It's kind of like when Obama decides to spend money on unions and says he is "investing".

5 posted on 02/23/2012 6:46:46 PM PST by ClearCase_guy ("And the public gets what the public wants" -- The Jam)
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To: Jet Jaguar

Funny, I just had a patient call today in regards to her Tri-Care dental benefits. I tried to explain to her they only cover 50%. She was not happy.

She called back, stating she spoke w/ them and they cover 100%. I took out her eob’s and told her exactly what was charged, told her they lied to her and they only cover 50% of her root canals.

Told her to look at her eob’s (which most people don’t understand, especially the elder ones). I gave her the breakdown of “patient pays”.

She said she couldn’t afford that and would have to make payments, which I said “of course, that’s not a problem”.

The MAJOR problem I face is that people, young and old think their medical/dental coverage covers 100%, which is bs.

Unless of course your on medicaid.....or decide not to pay for sh!t!


6 posted on 02/23/2012 6:59:54 PM PST by NoGrayZone (Jim "Firebrand" Robinson endorses Newt...with EPIC call to action!!)
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To: ClearCase_guy
The average cost to Tricare for a year’s worth of a brand name medication at retail is $1156 versus $840 through mail order. If generic drugs are substituted, the average falls to $200 a year, whether the drug is dispensed at retail, through mail order or base pharmacies.

The government not raising prices - it is not the one producing the drugs - it is transferring some of the costs to the consumers, thereby saving money for the rest of the taxpayers. The real net savings to consumer and taxpayer will come when people decide they don't want to spend co-pays of $136 a year for a drug that costs the taxpayers another $700, and ask their doctors for a generic for which they'll pay $36 and the taxpayers another $164.

I wish I could get brand-name drugs for $136 a year - that's what I pay for one of my generics, and generics is all I can afford.

7 posted on 02/23/2012 7:05:22 PM PST by heartwood
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To: Jet Jaguar
Any increase in what the parasites on Medicaid pay?

Ha ha ha of course not ... I crack myself up.

8 posted on 02/23/2012 7:21:14 PM PST by DuncanWaring (The Lord uses the good ones; the bad ones use the Lord.)
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To: Jet Jaguar
This is just posturing. The Ultimate Goal of this tricare BS is to force Retirees, Stateside Active Duty, and dependents into Obama care...


9 posted on 02/23/2012 7:21:19 PM PST by darkwing104 (Let's get dangerous)
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To: heartwood

I will only posit for consideration that these benefits constitute part of the payment to those who volunteer to serve in uniform and who therefore risk their lives for those who don’t. It’s part of the price we pay not to have the draft.


10 posted on 02/23/2012 7:21:29 PM PST by wiley
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To: Jet Jaguar

Tricare by mail is OK for meds for on-going needs, but when you’re constantly changing meds it would be a burden on the elderly, and I don’t see how they could even do it with some pain killers that require the patient to sign for the prescription and sign again for the delivery. We’ll see how it goes. Shame it has come to this - shortchanging vets reflects poorly on the nation, but most here know that.


11 posted on 02/23/2012 7:30:25 PM PST by Ace's Dad (Reagan Contra; in-country off the USS Racine.)
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To: Jet Jaguar

My Mom has Tricare for Life. Her copays jumped up by ten dollars a script a few months ago..November, IIRC..So, it’s going to jump more?


12 posted on 02/23/2012 7:43:32 PM PST by sockmonkey
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To: sockmonkey

Set her up for mail order/express scripts. The new prices became effective in October 2011 with generics rising from $3 to $5, brands from $9 to $12, and non-formulary from 22 to 25 at retail outlets. If you use mail order,the generics are free until 2016 and the copays are lower on brand names. Per 90 days, for brand name formulary drugs is $9 by mail order versus $36 at the local pharmacy.


13 posted on 02/23/2012 7:54:08 PM PST by jimnm
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To: jimnm
for brand name formulary drugs is $9 by mail order versus $36 at the local pharmacy.

That is what my Mom's are, so I will have to check out the mail order express scripts over CVS.. Thanx for the info. With gas and groceries through the roof, I hated it when her co-pays jumped, too.

14 posted on 02/23/2012 8:43:20 PM PST by sockmonkey
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To: heartwood

I wish the government would quit raising the cost of Medical benefits for Retirees.

I am sorry that your drugs are expensive, and you can only afford generics.

The government convinced men and women to go to war and put their lives in danger, to constantly move their families, etc, with the assurance of lifetime benefits after 20 years of Service.

Now they are changing the rules.

Servicemembers and Retirees are taxpayers, too. I laugh my butt off when I hear somebody say that as a “taxpayer” they think the Military should do this or that. Newsflash- we pay taxes too! Military pay is tax free for many Soldiers during deployment. But in real life, Servicemembers serve and pay taxes- and still get the shaft!


15 posted on 02/23/2012 9:47:52 PM PST by baileybat
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To: Jet Jaguar
Unless Congress intervenes this year, however, co-pay increases for brand name drugs at retail will not be modest this October. Retirees, their families and active duty family members would begin paying $26 per drug for brand names at their local pharmacies, up from $12. The co-pay thereafter would climb by $2 more each year until reaching $34 in October 2016. After that, co-pays would be adjusted yearly based on overall medical inflation.

Co-pays for brand name drugs at mail order also would jump to $26 from $9, for a 90-day supply, and then climb slowly to $34 by October 2016.

I have absolutely no problem with higher co pays for Brand Name drugs if there is a generic that can treat the problem effectively.

I am a pharmacist and pay 86 dollars co pay for a 90 day fill of Dexilant which is dexlansoprolol. This irritates the hell out of me. I had failed therapy on other generics in this medicinal class.

As a pharmacist I always encourage people to take the generic equivalent or the generic in the same class. However, their are certain situations in which there is no alternative to the Brand Name drug.

16 posted on 02/23/2012 10:12:00 PM PST by cpdiii (Deckhand, Roughneck, Mud Man, Geologist, Pilot, Pharmacist. THE CONSTITUTION IS WORTH DYING FOR!)
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To: Jet Jaguar
Huge fee hikes from the Obama Administration for Americans who served:

Zero fee hikes for Obama's protected voting block:


17 posted on 02/24/2012 3:39:54 AM PST by SkyPilot
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To: Jet Jaguar

Bend over and grab your ankles, Vets!


18 posted on 02/24/2012 5:34:20 AM PST by Redleg Duke ("Madison, Wisconsin is 30 square miles surrounded by reality.", L. S. Dryfus)
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To: Jet Jaguar

I’ve always gotten any meds we needed through the mail or at the MTF. I didn’t even realize there was an option of getting them at a civilian pharmacy.


19 posted on 02/24/2012 11:11:51 AM PST by GATOR NAVY
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To: Redleg Duke
I am just amazed at the brashness of this attack by Democrats and RINO Republicans.

For every illegal, for every lazy American, for every racial group with an ax to grind - the mantra is "giveitaway."

For Americans who fought, served, and bled for their country - the mantra is "soak them."

20 posted on 02/25/2012 4:17:17 AM PST by SkyPilot
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To: SkyPilot

Yes, that appears to be the deal with every democRAT president in my adult life.


21 posted on 02/26/2012 1:35:01 AM PST by jospehm20
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To: baileybat

First let me thank you for your service. Back in August of 1964 I was lead to believe that if I gave twenty years my health for myself and my wife would be taken care of. Twenty-six years later when I retired I found out they lied. My friend if we had never paid taxes, twenty years of service is payment in full for those benefits we were promised. If I had known the real truth I might have gone to Canada with the rest of the draft dodgers. Our service was payment enough.


22 posted on 03/08/2012 8:09:48 PM PST by Silver Fox 007
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