Military Officer - November 2007 - (Page 38)

washingtonscene Cut Your Drug Costs by 67 Percent ■ Contact the TRICARE Growth stimulating agents: Genotropin, retail pharmacy customer service line at (866) DODTRRX (363-8779) to discuss how to save 67 percent on pharmacy costs by using TRICARE’s Mail Order Pharmacy system. If any of your medications have a $22 copayment, they can identify alternatives available for $3 or $9 that you can discuss with your doctor. Humatrope, Omnitrope, and Saizen will be moved to the third tier, leaving Increlex, Nordiﬂex, Norditropin, Nutropin, Nutropin AQ, Serostim, Tev-Tropin, and Zorbtive available for a $9 copayment. Nasal steroids: Veramyst will be moved to the third tier, leaving Nasarel, Flonase, and Nasonex available for $9. The recommendations will be submitted to the assistant secretary of Defense for Health Affairs for a ﬁnal decision. It’s important to note DoD’s purpose in moving certain more expensive drugs to the $22 copayment level is to encourage beneﬁciaries who have been taking these drugs to talk to their doctors about switching to lower-cost medications that have been proven equally effective. If a doctor thinks it’s medically necessary for a patient to continue taking a third-tier drug (e.g., if alternative medications don’t work for the patient or cause adverse side effects), the doctor can request a “medical necessity” waiver. If TRICARE approves the waiver, the thirdtier drug would continue to be available to that patient for the $9 copayment. Unfortunately, DoD education efforts on this score have fallen short, with most beneﬁciaries simply paying the higher price when their drugs are moved to the third tier, without trying the alternative medication that should work equally well and reduce their copayments, to boot. At a $13 difference in a monthly copayment, switching to an alternative medication would save a beneﬁciary $156 a year. And switching to the mail-order system would save an additional $312 a year (because the same copayment buys a three-month supply in the mail-order system). For most people, paying $9 a quarter versus $22 a month would at least be worth a try. MOAA is pleased TRICARE has agreed to send letters to beneﬁciaries who have been taking Prevacid and other acid-reﬂux medications recently moved to the third tier and encourage them to discuss alternaNOVEMBER 2007 tive medication options with their doctors. Unfortunately, DoD could not guarantee that similar letters will be sent to all beneﬁciaries whose medications will move to the third tier in the future. Medicare, TRICARE Fixes Delayed Payment-cut reversal might wait until December. E arlier this year, the House passed the Children’s Health and Medicare Protection Act, which, in addition to increasing coverage of lower-income children under Medicaid, would have reversed the 9.9-percent cut in Medicare/TRICARE payments to providers scheduled to take effect on Jan. 1 under current law. Instead, the bill proposed modest increases in doctor payments for 2008 and 2009. This is a crucial issue, both for the elderly and for all military beneﬁciaries, because Medicare is one of the lowest-paying plans in America and TRICARE payments are tied to Medicare’s. Today’s payment rates are similar to those in 2001, while doctors’ costs have risen signiﬁcantly in the past six years. If payments are cut further, it will only lead to more doctors refusing to see Medicare and TRICARE patients. MOAA had hoped the children’s health bill would be a vehicle for quick action on Medicare/TRICARE payments. Unfortunately, that didn’t pan out. The Senate equivalent bill did not include the Medicare/TRICARE payment ﬁx, and congressional leaders decided to drop that provision in the interest of passing a “clean” bill on children’s health coverage. House and Senate leaders say they’re still committed to preventing the cuts in doctor payments from taking place, and MOAA 38 MILITARY OFFICER

Table of Contents Feed for the Digital Edition of Military Officer - November 2007

Military Officer - November 2007 Contents From the Editor President’s Page Your Views MOAA Directory Rapid Fire Washington Scene Chapters in Action Financial Forum Ask the Doctor Cover Story: Commanding the Corps With Love, From Home Financial Guidebook Financial Tuneups Banking on Your Time Pages of History MOAA Scholarship Recipients Faces of MOAA MOAA Scholarship Donors Member Books Advertising Index MOAA Calendar Sounding Taps MOAA Member Services Encore

Military Officer - November 2007

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