Posted on: Monday, July 4, 2005

MILITARY UPDATE

By Tom Philpott

More than 128,000 military beneficiaries taking Viagra or Cialis for erectile dysfunction likely will have to switch this fall to Levitra or face higher co-payments on their prescriptions.

The Defense Department's Pharmacy and Therapeutics Committee will recommend in mid-July that Dr. William Winkenwerder Jr., the Pentagon's top health official, narrow the field of impotency drugs dispensed for free at base pharmacies or for a $9 co-payment through the military's retail pharmacy network or mail-order program.

After a detailed review, the P&T committee concluded that none of the popular impotency drugs is more clinically effective, but Levitra is cheaper to stock. Only 10 percent of military patients with erectile dysfunction use Levitra. Seventy-seven percent use Viagra and 13 percent Cialis.

To save taxpayers $13 million a year, the committee proposes that Viagra and Cialis be moved to "non-formulary" status. If Winkenwerder agrees, these drugs no longer will be available on base unless a doctor claims medical necessity. Patients still could get Viagra or Cialis through the TRICARE retail network or by mail order but for a higher $22 co-payment.

On June 27, four of eight members of a beneficiary advisory panel that reviews P&T recommendations advised Winkenwerder to accept this one. Assuming he will, the panel also advised that the change take effect in 120 days, rather than 90, given the number of patients expected to switch.

In other healthcare news, military officials concede that some retirees will see higher costs if the Base Realignment and Closure Commission accepts a plan to downsize nine stateside hospitals to outpatient clinics and to refer patients needing hospitalization to civilian facilities.

Most of these patients, however, still will be treated by military physicians under facility-sharing arrangements with local communities, said Lt. Gen. George Peach Taylor Jr., the Air Force surgeon general.

Taylor chaired the Medical Joint Cross-Service Group that shaped the draft BRAC recommendations on healthcare. The downsizing plan, if accepted by the commission, will impact 148 inpatients a day, 6 percent of all inpatients treated in military stateside hospitals.

Even if patients are treated off base by military physicians, their out-of-pockets costs will rise because TRICARE fees and co-payments for off-base care will apply. Some lawmakers and military associations have criticized the move as an attempt by the Bush administration to deny on-base medical care to more service beneficiaries, particularly retirees and their families.

Taylor, however, said the actual goals are to create a more cost-efficient medical system, improve patient care and enhance medical staff skills and combat readiness.

Hospitals slated to be downsized to clinics or outpatient surgery centers are at the Air Force Academy, Colo.; MacDill Air Force Base, Fla.; Great Lakes Naval Training Center, Ill.; Scott Air Force Base, Ill.; Andrews Air Force Base, Md.; Keesler Air Force Base, Miss.; Marine Corps Air Station Cherry Point, N.C.; Fort Knox, Ky.; and Fort Eustis, Va. The estimated cost savings will be $62 million a year.

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