Health Care Happenings

Happy New Year?

2012 didn’t start out so Happy

In fact, President Obama and the Secretary of Defense Leon Panetta rolled out their plan to cut defense spending by $450 billion over the next decade.  Maybe you saw MOAA’s report on the plan in last week’s Legislative Update, “Troops-Pay-Healthcare Cuts Coming.”

The plan to target troops, retirees and their families reminds me of the arcade game Wack-a-Mole, only there is nothing fun about this.  The threat of targeting military and retiree benefits for cuts, particularly health care, is nothing new–the difference is reality is less than a month away–then we’ll know more of the ugly details when the President submits his budget to Congress the first week in February.

In announcing his priorities outlined in a ‘Sustaining U.S. Global Leadership: Priorities for the 21st Century Defense,’ the President stated,

“Most importantly, we will keep the faith with our troops, military families and veterans who have borne the burden of a decade of war and who make our military the best in the world.”

In reading the report I noticed a great deal of focus on national security, cost of doing business, economic challenges, rebuilding readiness, reducing manpower costs and reductions in the growth of compensation and health care costs…

It was a rather sterile report, with little mention of military people and their families–the very strength of our national security.

I don’t know about you, but I’m not going to let my military benefits be taken from me so easily–WILL YOU?

The impact of these cuts will be tremendous on my family–and, even more devasting to those with far fewer resources.

There are always unintended consequences in budget cuts like these.

I’m going to do all I can to let my legislators know this is unacceptable–and, I’m going to tell my military friends and their families to use there voice too.  MOAA makes it easy to let your members of Congress know what you think about these cuts and other issues.  We also like to tell your stories.

Silence isn’t good–it just signals to policy and law makers that everything is okay.

But it takes all our stories–all our voices to turn this tide.  Let’s pull the plug so there will be no more WHACKING our military, retirees, veterans, and their families and survivors.

Use your voice and DO SOMETHING FOR YOU, YOUR FAMILY AND OUR MILITARY COMMUNITY–sign up for MOAA Legislative Updates to stay informed and let us help you take action–visit www.moaa.org/email or call MOAA’s Member Service Center at 800-234-MOAA (6622).

So What Will You Do This Year to Stop the Cuts? 

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.

Back to my earlier posting question:

“Which blood pressure reading, those done by a medical provider or those done in the home are most likely to provide you with your ‘true’ reading?”

AND THE ANSWER IS  …  according to a Department of Veterans Affairs (VA) funded study at the Durham VA and Duke University …

“The study suggests that regardless of where the blood pressure is taken, the best way to get an accurate reading – to know the patient’s ‘true’ pressure – is to take at least 5 or 6 measurements on different days and use the average.”

We’ve probably all experienced spikes in our blood pressure readings when we go to the doctor.

Who wouldn’t.

               Going to  the doctor is not usually something we do for fun!

At the doctor’s office we may be nervous about the appointment or we’ve been rushing around just to get to the office on time–all things that might cause our pressure to spike.

This isn’t surprising and not a little known fact – RIGHT?

But, did you know that:

• This rise in pressure is known as the “white coat syndrome?                                                                                                
• Some of these spikes may be due to sloppiness in how the clinic readings are done?

     In a Johns Hopkins University editorial following the VA-Duke study, the University wrote,

“In practice, blood pressure measurement is remarkably casual.”

    “As clinicians and patients, we have personally observed major deviations from accepted standards:  Blood pressure cuffs applied over clothing…Readings taken without allowing the patient to rest for 5 minutes…Measurements are taken while the patient sits hunched over an examination table with his or her legs dangling…Even small differences in the patient’s arm position can make a difference of a few millimeters of mercury.”

• Lack of consensus in treatment guidelines on the setting, timing and total number of blood pressure measurements that should be used for decision making?

…Millions of patients could be on hypertension drugs they don’t really need, said a Duke assistant professor of medicine.

• High blood pressure is the most common reason older adults visit the doctor?

So it seems as though the bottomline to all these facts is the need to have frequent and accurate blood pressure measurements.  We already know that hypertension is a strong risk factor for heart disease, so having ‘true’ readings can impact patient diagnoses, treatment and outcomes.

Researchers in the study also said, that by shifting from clinic-based blood pressure monitoring, using tools such as telemedicine, have the potential to create efficiencies and cost savings in the health care system.

So the next time you go to the doctor or take your blood pressure at home, follow these simple guidelines:

1. No exercise, caffeine, or smoking at least a half-hour before measurement
2. Sit quietly for 5 minutes before the reading
3. Sit comfortably with your back supported, feet flat on the floor, and arm level with your heart during the measurement
4. Sleeve should be rolled up during the procedure
5. No conversation with clinicians or others during the procedure
6. The blood pressure cuff should be the right size and fit correctly
7. For first visits, 2 blood pressure readings should be taken–if they vary significantly, a 3rd reading should be done

REMEMBER

“Multiple readings at a single office visit is not as valuable as having the patient do several readings at home, on different days!”

Tis the Season!

The time of year where the hurried and harried get caught up in the Holiday race.  It’s enough to cause anyone’s blood pressure to rise.

But what about the rest of the year.  Do you know what your ‘true’ blood pressure measurement is?

          So is your blood pressure a little high?  …  Or, a little low?

Do you rely on your medical provider to tell you your pressure readings? 

          Or, do you or a family member take your blood pressure readings at home?

Or, do you rely on both your medical provider and your home readings to give you your ‘true’ pressure?

So here’s my question to all you readers to answer:

Which blood pressure reading, those done by a medical provider or, those done in the home, are more likely to provide you with your ‘true’ reading?

I’d like to hear from you. 

Tell me what you think, and I’ll be back this week to tell you some little known facts about blood pressure you and your health care provider may not know.

Maybe you have a little known fact about blood pressure readings to share with us as well.

Can’t wait to HEAR FROM YOU!

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.

“At our hearing in July I requested that Department of Veterans Affairs (VA) survey their frontline mental health professionals about whether they have sufficient resources to get veterans into treatment…The results that came back were not good.

               Nearly 40%  said they cannot schedule an appointment in their own clinic within the VA mandated 14-day windo

               70% said they did not have adequate staff or space to meet the mental health needs

               46% said the lack of off-hour appointments prevented veterans from accessing care.”

                     Chairman Patty Murray, Senate Committee on Veterans Affairs

    

Yesterday, Chairman Murray held a follow-on hearing to address the VA survey and continue to probe barriers preventing veterans from getting the mental health services in VA Health Administration (VHA) they need and want.

As the hearing progressed, it became clear that there was a disconnect between wait times data being reported by mental health providers and VA Central Office Mental Health Operations officials.

One withness, a Coordinator for Post-traumatic Stress Disorder (PTSD) Services and Evidence Based Psychotherapy at the Wilmington VA Medical Center and a representative for the American Federation of Government Employees, provided dozens of examples of VA employee comments that expressed similar concerns highlighted in the VA survey mentioned above:

• “Social workers at my facility universally feel extremely overworked and overwhelmed…
• She is overbooked every day–her caseload of more than 200 patients, including high risk patients, is simply unrealistic…
• Poor staffing in the general mental health clinic makes it difficult if not impossible to refer veterans for ongoing general mental health services.”

On the other hand, VA officials told the Committee that the Department believes it has unprecedented resources to adquately execute the mission but will continue to aggressively follow the data in order to make good predictions on needed resources and funding.

Additionally, VA’s response to the survey results was to put together an action plan and conduct more focus groups, audits and to implement more policy and guidelines.

MOAA agrees with Chairman Murray and the Committee members.  The issues of access and the barriers that prevent veterans from getting the care they need are not new.  And, they need to be fixed NOW!

Isn’t it time VA stopped playing catch up and start addressing the massive numbers of veterans entering their system and the ones who will soon be coming back from Iraq and Afghanistan.  Or will it take another 10 years to catch up to the challenges that exist in VA now?