Vets! Tricare users: start of price increases...

[babylonsister]

I picked up my regular medication yesterday and, as of mid-February, the price has increased from a co-pay of $3 to $22 per month. :wtf:
The reason is that it's now considered a non-formulary, so here's an article (about HMOs in general, not Tricare specifically) that provides an explanation. Let's just say I'm skeptical of this getting better any time soon.


http://www.webmd.com/content/article/11/1691_50063.htm

Battling the HMO Formulary

Your health plan may not cover the drugs you want.
By Kathleen Doheny

If your case is average, your managed care plan spends about $117 on you each year for prescription medicines. The typical managed care plan spends a considerable chunk of its budget -- an average of 11% -- on prescription drug costs, according to the SMG Marketing Group in Chicago, which gathers this data each year.

So from a business point of view it's understandable why managed care organizations want to cut costs on prescription drugs as much as they can.

Thus was born the formulary -- the list of drugs that doctors may prescribe under the plan. Typically, a managed care plan relies on a committee made up of physicians and others to decide which drugs will appear on its formulary. The committee evaluates the safety and effectiveness of each drug, and if they judge that two drugs are equally effective, they generally opt for the one that costs less.

Some disgruntled consumers say formularies are all about saving money. But that's not so, says Susan Pisano, a spokeswoman for the American Association of Health Plans, an industry organization in Washington, D.C. "Formularies are put together with quality trumping cost," she says.

But drug manufacturers pressure the committees to include their products, says Steven Gray, PharmD, the pharmacy professional affairs director for the California division of Kaiser Permanente. "Drug manufacturers' sales representatives are trained and motivated to sell their drugs, and there are big bucks involved."

more...


And here's a link to Tricare's third tier chart

http://www.troa.org/serv/serv_wellness/serv_healthcare_third_tier/serv_healthcare_drug_formulary/serv_healthcare_drug_formulary_3rd_tier.htm

[MADem]

1. I have a military family member in the household who cannot get

one particular drug at the base anymore....talk about a massive pain in the ass. They've removed it from the formulary, so it's either get the doctor to choose a substitute, or fill prescriptions hither and yon.

Wow, I note from the TROA chart they kept ONE boner pill on the friken formulary (Levitra!). Which cabinet member has stock in that company--Rummy????

[enlightenment]

4. Can't they mail order?

My parents (retired) get their meds through Tricare mail order, since they live in the back of beyond. The get 45 day supplies rather than 30 when they mail order. Is that not possible for your family member? I'm not very familiar with Tricare beyond the little I understand from my folks.

I did just check to see if they had upped the cost of my dad's cancer drug, Gleevec. He would be dead now if he didn't have Tricare -- the drug costs between $2,600 and $3,600 for a 30 day supply.

[MADem]

5. Mail order costs are the same as the pharmacy

On base, the medications are FREE for retiree MFM's (PC phrase for what used to be called "dependents"). Quite frankly, they SHOULD be--that is what was promised--free health care for life. Treatment on base is also free, but good luck getting into a clinic nowadays--it is virtually impossible. Active duty has priority, and half the docs are in Iraq, Qatar, Germany, or doing double shifts at a military medical facility caring for the kids coming back from the sandbox. And forget about getting any treatment from the hospitals; they're stacked to the rafters with the poor wounded kids.

You can actually get 90 days of drugs through either mail order OR the base pharmacy, which makes those more convenient. To get them through the drugstore, you have to have the doctor insist in writing on the script that the whole damn thing be filled, and then they charge you for the three month's supply.

[enlightenment]

6. Oh. okay.

My folks haven't lived near a military base since 1985 (Denver -- they would go to Fitzsimmons), so I didn't realize the difference.

I agree that they should be able to get the care they were promised. I always thought it was bizarre that my dad (not to mention mom) couldn't use the VA Hospital in one of the towns they lived in. He had 32 years in the AF, retired a full bird -- but was never permanently injured while serving, which I'm told has something to do with it.

Good luck to you family member -- it's a ridiculous situation that they shouldn't have to deal with.

[MADem]

7. If he is of a certain age (the medicare set) and has Medicare Part B

then his treatment should be essentially free. What medicare doesn't cover, Tricare does. The gray area is retirees who have not yet become medicare eligible--Tricare pays, but they pay the overage, not having Medicare.

[enlightenment]

8. It is, pretty much.

He's almost 84 -- in the last 5 years he has had three stent procedures for blockage, 1 surgery for intestinal blockage (which found the weird cancer he has -- called GIST), surgery to remove the GIST tumor and ablate the liver, the chemo with the Gleevec, a massive coronary that resulted in a 14 day hospital stay with pacemaker/defibrillator/stent combo.

Now the cancer is back.

I call him the bionic man, given all the implanted metal in his body -- and it's funny that despite all those issues, he is still mobile (though not terrible strong) and entirely compos mentis!

[MADem]

9. I'll bet his costs are stuff like the crappy hospital food, and

the bedpan and pee funnel that they give you, like a parting gift from an antiseptic game show!!! IIRC, those accoutrements are extras!

[enlightenment]

10. Indeed!

:rofl:

It's really not funny, but the way you put it is!

[MADem]

11. Being in the hospital sucks, so ya gotta laugh

If you don't, you'll cry!!!

[enlightenment]

12. True.

I spend so much time keeping everyone upbeat when I'm with my folks -- sometimes I forget to laugh when I get home.
Thanks.

[UTUSN]

2. Blue Cross is $75 for non-generic, $30-generic co-pay. And

LIPITOR costs $250 full price. Just saying.

[oneighty]

3. My wife is on CHAMPVA

Strange happenings there too having to do with their purchasing of drugs.

They will say; "Those drugs are on back order from the manufacturers. Check back every two weeks."

So we are sent to fill scripts at our local drug store which requires a 20 percent co-pay.

180