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So it appears our benefits are being reduced again; this time through denial of coverage for compounded medication. TriCare is now denying by ingredient. They started out slowly, but the list grows longer each month. So when I went to get a refill of my 7 component cream, 4 of the ingredients are no longer covered. So the $20 copay is now $107 full price. That means the retired disabled Vet gets hammered again.
Compounded creams are frequently used to address pain and inflammation in localized areas. Many times the non steroidal anti inflammation drug is in a higher dose than taken orally which the liver would hate. For me, I don't use this stuff every day, but when I need it, it's the difference between functioning and suffering. I'm fortunate to be able to afford it, but there must be many out there that can't take the hit.
Compounded creams are frequently used to address pain and inflammation in localized areas. Many times the non steroidal anti inflammation drug is in a higher dose than taken orally which the liver would hate. For me, I don't use this stuff every day, but when I need it, it's the difference between functioning and suffering. I'm fortunate to be able to afford it, but there must be many out there that can't take the hit.
Medical
Posted >1 y ago
Responses: 3
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CAPT Kevin B. I've written about the end of compound pharmacy coverage as well.
In today's Military News, comes word that our benefits are being attacked again, with more huge increases in Pharmacy copays, and more cuts for Active Duty folks. Our CONgress, including the GOP have no clue what it means to be military, and they have no compunctions about violating the promises made to us...
http://www.military.com/daily-news/2015/09/30/congress-agrees-boost-tricare-pharmacy-copays-2016-defense-bill.html?ESRC=navy-a_150930.nl
In today's Military News, comes word that our benefits are being attacked again, with more huge increases in Pharmacy copays, and more cuts for Active Duty folks. Our CONgress, including the GOP have no clue what it means to be military, and they have no compunctions about violating the promises made to us...
http://www.military.com/daily-news/2015/09/30/congress-agrees-boost-tricare-pharmacy-copays-2016-defense-bill.html?ESRC=navy-a_150930.nl
Lawmakers Agree to Boost Tricare Pharmacy Co-Pays in 2016 Defense Bill
Lawmakers agreed to increase pharmacy co-pays that largely affect military retirees.
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CAPT Kevin B. I am experiencing the same thing. I have written to the Defense Health Agency regarding this, and they, instead of responding to it, forwarded it to Express Scripts (ESI) for action. I am very troubled by this for several reasons.
1) OSD Defense Health Agency provides no direct phone number for beneficiaries to contact them. It is possible to write to them at
Office of the Assistant Secretary of Defense
Health Affairs
7700 Arlington Blvd., Suite 501
Falls Church VA 22042-5101
But, chances are they will just forward the issue to Express Scripts for action.
2) ESI is the pharmacy benefit manager AND the pharmacy dispenser. This creates a conflict of interest, as there is no effective oversight.
3) Grievances against ESI are to be sent to ESI, rather than OSD, which again, is the fox guarding the henhouse.
4) The information put out by TRICARE at the beginning of the year regarding this is different than what they are saying now, that the ingredients in compound creams are not FDA approved, so they won't authorize them.
5) Ultimately this is about money more than anything else - it is very clear that SECDEF doesn't really care about the needs of retirees and other military beneficiaries. If he did, the budget shortfalls would not be made up primarily by cutting healthcare benefits and military compensation.
6) For creams that you are ALREADY getting, your doctor needs to now call [login to see] for PRIOR AUTHORIZATION (PA). It seems absolutely crazy to me that you have to get PA for a medication that TRICARE already paid for.
7) The alternatives include high doses of muscle relaxers and narcotics, which create huge systemic problems.
I really wish that the military could go on strike - CONgress, SECDEF and POTUS need a wake up call...
1) OSD Defense Health Agency provides no direct phone number for beneficiaries to contact them. It is possible to write to them at
Office of the Assistant Secretary of Defense
Health Affairs
7700 Arlington Blvd., Suite 501
Falls Church VA 22042-5101
But, chances are they will just forward the issue to Express Scripts for action.
2) ESI is the pharmacy benefit manager AND the pharmacy dispenser. This creates a conflict of interest, as there is no effective oversight.
3) Grievances against ESI are to be sent to ESI, rather than OSD, which again, is the fox guarding the henhouse.
4) The information put out by TRICARE at the beginning of the year regarding this is different than what they are saying now, that the ingredients in compound creams are not FDA approved, so they won't authorize them.
5) Ultimately this is about money more than anything else - it is very clear that SECDEF doesn't really care about the needs of retirees and other military beneficiaries. If he did, the budget shortfalls would not be made up primarily by cutting healthcare benefits and military compensation.
6) For creams that you are ALREADY getting, your doctor needs to now call [login to see] for PRIOR AUTHORIZATION (PA). It seems absolutely crazy to me that you have to get PA for a medication that TRICARE already paid for.
7) The alternatives include high doses of muscle relaxers and narcotics, which create huge systemic problems.
I really wish that the military could go on strike - CONgress, SECDEF and POTUS need a wake up call...
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