Health Care Happenings

Before the holidays we provided an update on the ongoing Walgreen’s – Express Scripts negotiations and the plan for the way ahead if not resolved.  We now know that Walgreen’s will cease to be a network provider for TRICARE through the Express Scripts government contract.  Below we have addressed many of the questions that our blog readers had.  Here they are:

Responses to MOAA Members Concerns

1. Why isn’t TRICARE weighing in on the dispute between Walgreens and Express Scripts?

According to the September 15, 2011 American Forces Press Service article, “TRICARE Promises Continued Access to Prescription Meds.” Navy Rear Adm. Christine Hunter, deputy director of the TRICARE Management Activity, called the dispute between Walgreens and Express Scripts, Inc. “a business matter.”

RADM Hunter also stated, “Don’t let that advertising, letter and Internet outreach campaign scare you. Even if contract renewal negotiations fall through and Walgreens drops out of TRICARE’s retail pharmacy network on Jan. 1, beneficiaries still will have plenty of other options for getting their prescriptions filled.”

To read the full article, please visit http://www.defense.gov/news/newsarticle.aspx?id=65353

2. I am concerned about the safety of my medications when they sit in my mailbox all day.   

Throughout the year, Express Scripts works diligently to ensure your medications are sent to you in the safest way possible and in compliance with the medication manufacturers suggested shipping standards.  According to Christopher Meilinger, a Senior Pharmacy Director at TRICARE Pharmacy Home Delivery, “The vast majority of non-refrigerated medications are not negatively affected by the temperature differences seen during the normal shipping process. Express Scripts has done, and continues to do, research into the stability and potency of various medications as it relates to shipping during all months of the year. Using the research and information obtained from pharmaceutical manufacturers, medications are evaluated for the need for special packing and shipping processes during the warmer months of the year.”

Express Scripts pharmacists are available to answer questions you have about your medication 24 hours a day/7 days a week. Call 1-877-363-1303 to contact Express Scripts.

3. Can Express Scripts ship refrigerated medications to me?

Yes. Express Scripts will ship medications requiring refrigeration in cold packs. Please note, refrigerated medications cannot be shipped to APO/FPO addresses. To learn more, visit www.express-scripts.com/TRICARE or contact Express Scripts at 1-877-363-1303.

4. I am concerned that my medication could be stolen from my mailbox.

If your medication is stolen from your mailbox, contact Express Scripts at 1-877-363-1303. A Patient Care Advocate will work with you to obtain replacement medication.

5. I am going on vacation, and I do not have enough medication to last me while I am traveling.

If you do not have enough medication to last you while you are traveling, contact Express Scripts at 1-877-363-1303. A Patient Care Advocate will work with you to obtain a refill.

If you are traveling to a destination for a longer period of time, Express Scripts can ship your medications to a temporary address.

Express Scripts ships to the following destinations:

• All 50 states
• PO boxes
• APO/FPO addresses
• U.S. territories

To change your shipping address, contact Express Scripts at 1-877-363-1303 or update your address information online at www.express-scripts.com/TRICARE.

6. I normally have my prescriptions filled at Walgreen’s. Where can I find a listing of pharmacies who participate in the TRICARE program?

To find other pharmacies in your area who participate in the TRICARE program, Contact Express Scripts at 1-877-363-1303. A patient care advocate will locate participating pharmacies in your area, or go to www.express-scripts.com/TRICARE. Click on the Find a Pharmacy link in the Resources section. Enter your zip code to find a participating pharmacy.

You can also manage your prescriptions on the go with any Web-enabled mobile device to order refills, check status, find a pharmacy, and more. Visit http://www.express-scripts.com/mobile/ to learn more.

7. Do I have to contact Express Scripts every time I need my Home Delivery medications refilled?

No. Express Scripts offers an auto refill program, which takes the worry out of refilling your maintenance medications. Enrollment is free and when you enroll in this program, Express Scripts will automatically refill and mail your medication to you. Seven days before your medication is scheduled to be refilled, Express Scripts will notify you by phone or email that your prescription is going to be filled.  At any time before the prescription processes, you may cancel or reschedule the automatic refill. To register online for the auto refill program, visit www.express-scripts.com/TRICARE or call Express Scripts at 1-877-363-1303.

8. I like talking to my pharmacist when I pick up my medications.  Does Express Scripts offer the same service?

Yes. Express Scripts has pharmacists available 24 hours a day/7 days a week to answer questions about medication appearance, dosing, safety, side effects, drug interactions, temperature and medication sensitivity.  If you need to speak with a pharmacist, please call Express Scripts at 1-877-363-1303.

9. Can I order controlled substances through Home Delivery?

Yes, the home delivery pharmacy can fill a prescription for a controlled substance. In order to do so, your prescribing provider must provide his or her individual Drug Enforcement Administration number on the prescription and a complete street address. An adult’s signature is required upon delivery. Please note that controlled substances cannot be shipped to a PO Box.

Some controlled substances are not refillable by law. Check with your provider.

10. I recently had my prescriptions filled and noticed the copays have changed.  Can you tell me more about this?

On August 5, 2011, the Office of the Assistant Secretary of Defense (Health Affairs) approved changes to pharmacy copayments which go into effect on October 1, 2011. The following table provides the new copay structure as of October 1, 2011:

In a news release titled “TRICARE Reduces Pharmacy Home Delivery Co-Pays” dated September 7, 2011, Navy Rear Adm. Christine Hunter, deputy director of the TRICARE Management Activity, stated “These new copays make using TRICARE Pharmacy Home Delivery more affordable than ever” and “Home Delivery offers a great value for patients taking maintenance medications for chronic conditions.”

To read the full press release, visit http://www.tricare.mil/mediacenter/news.aspx?fid=736.

11. Over the last several months, my doctor has been adjusting my medications. I am concerned that if I use Home Delivery, I will be throwing away more medication than I use.

It is better to use a participating TRICARE retail pharmacy if your doctor is adjusting your medication. However, once your medication is adjusted, Home Delivery will provide you with more cost savings.

To begin using Home Delivery, go online to www.express-scripts.com/TRICARE and register or call the Member Choice Center at 1-877-363-1433.

There will be an important change to your pharmacy benefit effective the 1st of January 2012.  This concerns the retail chain of Walgreens.

As we have highlighted a few weeks ago, Walgreens will no longer be a part of the Express Scripts pharmacy network.  If you continue to fill your prescriptions at a Walgreens pharmacy after 1 January, you will have to pay 100% of your prescription costs and submit a paper claim for NON-NETWORK reimbursement, which will dramatically increase your out of pocket costs.

Walgreens remains in the TRICARE pharmacy network through Dec. 31, 2011, but the time for you to act is now.  According to ESI there are more than 56,000 pharmacies in the TRICARE network, excluding Walgreens.  On average, there is another network pharmacy within one-half mile of any Walgreens.  Now is also a good time to consider moving the medication you take on an ongoing basis to TRICARE Home Delivery.

Remember with the Home Delivery method you get:

1. Savings that add up quickly
2. Convenient delivery and refills (and refills come automatically..)
3. Safety
4. Personal service, as you can speak with a pharmacist anytime day or night from your home.

For more information on the Home Delivery option go to: www.express-scripts.com/TRICARE   and click on the ‘Get started with Home Delivery’ link on the left side of the screen.

Medicare – Making Informed Choices

Some MOAA members have been inundated recently with information from insurance companies regarding enrollment in Medicare Supplemental Insurance (Medigap plans) or Medicare Advantage plans. These can be confusing, so let’s review.

Original Medicare consists of Part A (Hospital Insurance) and Part B (Medical Insurance). Most retirees or their spouses paid Medicare taxes during their working years and don’t have to pay a monthly premium for Part A. Part B does require a monthly premium, which is means tested. To retain eligibility for Tricare beyond age 65, military retirees must be entitled to Part A and enrolled in Part B.

Medicare Supplements or Medigap plans help cover out of pocket expenses of Medicare beneficiaries. Tricare for Life acts as a Medigap plan for military retirees and spouses. You need no other supplements.

Part D is Prescription Drug Coverage. Most military retirees don’t need to join a Medicare Prescription Drug Plan. The drug plans are run by private companies approved by Medicare. Monthly fees vary by plan.

Sidebar: Surviving spouses who may lose their Tricare coverage due to remarriage, and anyone whose limited income qualifies them for Medicaid, should consider Medicare Part D coverage.

Medicare Advantage (MA) Plans, sometimes called “Part C”, combine Parts A and B, and usually Part D. Private insurance companies approved by Medicare offer these plans. The plans are run like a Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO), and can have a yearly deductible, co-payments, additional monthly premiums above Part B premiums, and restrictions on referrals to out of plan providers, as well as yearly limits on out-of-pocket expenses. MA plans must include the coverage obtainable from Original Medicare, except hospice care (Original Medicare covers hospice care even if you’re enrolled in a MA plan). MA plans usually offer additional services such as vision, hearing, dental and/or wellness programs to make them more attractive to some retirees. The insurance companies providing these plans are heavily subsidized by the federal government, though those subsidies are being squeezed by tightening budgets and by changes in health care policy expected to go into effect in the next few years.

When a MOAA member contacts me regarding whether or not to enroll in a Medicare Advantage plan, I always ask first if Part D coverage is required to join that plan. If it is, I advise them to look for another plan, or choose Original Medicare. If a Medicare Advantage plan’s network pharmacy is also a Tricare network pharmacy, the plans may coordinate benefits. However, the potential savings or additional services obtainable from a MA plan rarely offset the added premiums required for Part D coverage (average $30/mo in 2011) and the potential hassle of coordinating drug benefits. If a plan does not require Part D enrollment, proceed with caution.

Once the Part D requirement is determined, the member should carefully evaluate and compare the features of the MA plans under consideration. If the plan offers features that you will likely never need or use, or cover in another way, then it isn’t worth paying any additional money to belong to that plan.

Next, if you want to use your own health care providers, determine whether or not your provider is a member of that MA plan. The best way is simply to ask your doctor if he or she participates in any Medicare Advantage plans. Some MA plans require that you get all of your care from providers in their network (emergencies are usually exceptions). Some MA plans require referrals from a primary care doctor. Some plans allow greater choice of providers, but will charge you extra if you get care from someone outside the network.

Finally, Medicare Advantage plans are offered regionally, and can vary widely around the country of even your state. If you live in more than one place in retirement, a MA plan might not be good choice.

With all the different rules from plan to plan, many retirees decide to keep things simple and stay with Original Medicare. That’s not a bad choice. Tricare-eligible retirees can use Original Medicare and Tricare for Life to great advantage.

Whatever decision you make it isn’t permanent. Most plans have enrollment periods each year. You may be stuck with your decision for a year though, so choose carefully.

For more information, see Medicare’s Plan Finder tool at www.medicare.gov/find-a-plan

Source: Medicare & You, Centers for Medicare and Medicaid Services, 2011

What exactly are the specifics of the President’s plan to cut military health benefits?

TRICARE For Life:

(a) Establish an annual enrollment fee of $200 per person, starting in FY2013

(b) Authorize the Secretary of Defense to increase that fee in subsequent years based on growth in health costs

TRICARE Pharmacy copays:

(a) Switch retail copays from a flat dollar amount to a percentage of DoD costs. For FY13, that would be 10% of cost for generics and 15% of cost for brand names. the White House plan envisions further increases in subsequent years to 20% of cost for generics and 30% for brand names.

(b) Leave generics at zero copay in the mail-order system, but increase the mail-order copay for brand names to $20 and non-formulary medications to $35 for FY13. The White House plan envisions increasing both of those to $40 in subsequent years.

MOAA strongly objects to these proposals. You can help by sending your legislators this MOAA-suggested message.

Your feedback is valuable! 

TRICARE would like you to tell them how you get your prescriptions filled and what you think about saving 66% or more on the medications you use on a regular basis.

As part of our effort to partner with TRICARE , they are requesting participation by our MOAA members to provide information on a short questionnaire which can be found here:  https://tricare.inquisiteasp.com/cgi-bin/qwebcorporate.dll?idx=D9GAC7

Please take a minute or so to offer your opinion on recieving your medications via the cost effective home delivery method.      Thank You!

Yesterday, the Secretary of Labor the Honorable Hilda Solis, introduced the Trauma-Informed Care for Women Veterans Experiencing Homelessness:  A Guide for Service Providers, also known as the “Trauma Guide.”  This comprehensive guide was created to address the unique psychological and mental health needs of women veterans.  Specifically written for service providers, it’s primary goal is to improve the engagement effectiveness of the female veteran population.

Through the effort to better understand the factors which would lead women to become homeless, the Women’s Bureau at the Department of Labor conducted extensive qualitative research, which revealed that the experience of multiple traumas increases the risk of homelessness and severely impacts women veterans’ ability to re-adjust to civilian life.

Consider these facts about our growing number of military women:

Women are now 20% of new recruits, 14% of the military as a whole, and 18% of the National Guard and Reserve.  While women represent only 8% of veterans, their risk factors are rising disproportionately to their numbers.  Women veterans are at 4 times greater risk of homelessness than their non-veteran civilian counterparts.  Over the last decade, the number of homeless women veterans has nearly doubled, with a significant number having children.  Further research suggests that 81-93% of female veterans have been exposed to some type of trauma either during their service or prior to joining the military.

Thus, the experience of trauma and the subsequent impact on daily functioning can present a significant challenge as women veterans re-adjust to civilian life, and can be a risk factor for homelessness. Women veterans also have unique challenges compounded by their military experiences and multiple roles as breadwinner, parent, and spouse.

• Female veterans who are homeless have significant histories of trauma.
• Exposure to trauma impacts all aspects of daily functioning.
• Female veterans do not always self-identify as veterans.
• Female veterans often find themselves without a support network.
• Few current services exist which address and are tailored to the needs of female veterans.       

So as we seek to further understand how the experiences of trauma impact our female veterans, it is the hope that by using this guide as a framework to tailor services to women;  that providers, organizations and we in the community will be better able to facilitate the recovery and re-entry of our women.

For more information please go to www.dol.gov/wb