MILITARY UPDATE
Questions surround changes in pharmacy services
Military Update focuses on issues affecting pay, benefits and lifestyle of active and retired servicepeople. Its author, Tom Philpott, is a Virginia-based syndicated columnist and freelance writer. He has covered military issues for almost 25 years, including six years as editor of Navy Times. For 17 years he worked as a writer and senior editor for Army Times Publishing Co. Philpott, 49, enlisted in the U.S. Coast Guard in 1973 and served as an information officer from 1974-77.
By Tom Philpott
By this time next year, 1.5 million beneficiaries using military pharmacy services could be under a new "uniform formulary" that regulates what drugs they get free from base pharmacies, or for co-payments of $3 (generic) and $9 (brand) from the TRICARE retail network and the military mail-order drug plan.
Medicines not on the uniform formulary still would be available through the retail network and mail order but at a higher non-formulary co-payment of $22 per prescription, according to interim rules published April 12 in the Federal Register.
How the two changes — a uniform formulary and $22 co-payment for non-formulary drugs — would affect beneficiary out-of-pocket costs is difficult to assess until Defense officials decide how restrictive the new formulary will be.
"If it's inclusive and my folks can get the medications they're used to getting, then we have no problem," said Sue Schwartz, deputy director of government relations for The Retired Officers Association. "If they really ratchet down and make it hard to get the medication (then we have a problem.)"
Non-formulary drugs would be available at formulary co-payments if physicians document a clinical necessity. But an issue for patients will be the ease of that documentation process.
"I mean how many hoops are they going to make people jump through to get medications they already have been on?" Schwartz said.
The association wants a grandfather clause to shield patients from $22 co-payments on present medications.
Driving the pharmacy reform initiative is language in the 2000 Defense Authorization Act that the Pentagon "establish an effective, efficient and integrated pharmacy benefit."
Congress said a re-engineered pharmacy plan must include, at a minimum, a uniform formulary across all military pharmacy services including base pharmacies, the TRICARE network of retail pharmacies and the military's National Mail Order Pharmacy Program.
Under the proposed plan, active duty members would continue to get all medicines free. Also, all prescriptions that can be filled on base would be free. But in moving to a uniform formulary, officials propose a three-tier co-payment structure for the retail drug network and the mail-order program.
Two tiers already exist: $3 for generic drugs, $9 for brand name. Under three tiers, co-payments would be $3 for generic, $9 for formulary brand drugs and $22 for non-formulary brands.Ê Those co-payments would cover a 30-day supply from network retailers and a 90-day supply from the mail-order program.
If prescriptions are filled at non-network pharmacies, the co-payment for a 30-day supply would be 20 percent or $9, whichever is greater, for a formulary drug and 20 percent or $22 for a non-formulary drug.
Defense officials said final rules would not be published for at least a year. An open comment period on the interim rules will expire June 11.Ê Comments should be sent to: Medical Benefits and Reimbursement System, TMA, 16401 East Centretech Parkway, Aurora, CO 80011-9066.
Reserve retirement
With more than 80,000 Reserve and National Guard members mobilized for the war on terrorism, a bill sponsored by Rep. Jim Saxton (R-N.J.) to lower the age at which reserve retired pay begins — from 60 down to 55 — is gathering sponsors on Capitol Hill.
In recent years, Defense officials have been studying ways to make Reserve duty more attractive and rewarding, given the expanding role for reservists in military readiness and, since Sept. 11, in homeland security.
Lowering the age at which reservists draw annuities is one idea under review. An enlisted reservist who serves 20 years might only be 37 or 38 yet annuities don't begin, under present law, until age 60.
Passage this year is unlikely, but Saxon said he has been astonished by the response from reservists and supporters.
Questions, comments and suggestions are welcome. Write to Military Update, P.O. Box 231111, Centreville, VA 20120-1111, or send e-mail to: milupdate@aol.com.
