Readers of Tom Philpott’s Military Update column sound off.

Behind the Jump to $22 Co-Pays for Heart Medicine

In a recent column you stated that the Department of Defense has proposed raising the co-pay from $9 to $15 on brand name drugs filled through the TRICARE retail pharmacy network.

But just recently I paid $22 for a 30-day supply of Altace, a blood pressure medicine for which I previously paid $9. As a widow who is on a limited income, this change is big. Why the increase?

I get all my other prescriptions through the pharmacy at a military facility. But Altace is not available there.

BILLIE J. VAUGHN
Via e-mail

The price change for Altace resulted from the Department of Defense’s Uniform Formulary process. Starting a year ago, the DoD Pharmacy and Therapeutics (P&T) Committee, comprised of pharmacy experts and physicians, has been meeting quarterly to review and recommend classification of prescription drugs into one of three cost-share tiers, based on their clinical effectiveness and cost to the government.

When drugs of the same class are found to be equally effective but have a cost disparity, the lower-priced drugs are recommended for the Uniform Formulary and higher priced drugs for “non formulary” status, which means a $22 co-payment in the TRICARE retail network and mail order program.

A Beneficiary Advisory Panel (BAP) reviews P&T recommendations from a patient’s perspective and concurs, non-concurs or recommends a change in implementation date. The final decision to shift a drug to non-formulary status is made by Dr. William Winkenwerder Jr., assistant secretary of defense for health affairs. Officials estimate that the Uniform Formulary process, combined with better drug contract management, has to date saved the government $500 million.

The P&T Committee recommended Altace for non-formulary status last August, finding it no more effective than alternative medicines to treat high-blood pressure. The BAP expressed concern. Winkenwerder in November accepted the P&T recommendation.

“The Committee did recognize that there is an important role for Altace in the treatment of some high-risk patients with a history of cardiovascular disease and the drug will be available at the formulary cost share if medical necessity is documented,” said Captain Patricia Buss, chairperson of the P&T Committee.

Medical necessity forms are available on the TRICARE Pharmacy Web site: www.tricare.osd.mil/pharmacy/medical-nonformulary.cfm. Procedures for completing and submitting medical necessity information are on the forms.  – Tom Philpott

20-20-20 RULED OUT

My ex-husband and I were married for 34 years. He was in the Air Force for 21 years. Of those 21 years, I was married to him for 19 years and 11 months.

In September of 2002 he informed me that he wanted a divorce. He left me for my best friend of 40 years. As if that blow was not enough, I found out that because I was a month short of the 20 years of marriage while he was in the military, I am not entitled to the medical benefits I counted on. I was given only a year of coverage from date of the divorce.

I understand that medical care is a privilege but I gave up my career years to follow him around the country and provide for our children in his absence. Being one month short of getting coverage is really upsetting.

I have contacted both my congressman and senator and received their pat answers. Has there been any rumor of change? 

SHERRY PERINOVIC
Las Vegas, Nev.

Congress has been neglected making reasonable changes to the Uniformed Services Former Spouses Protection Act. Lawmakers fear that even discussing reforms would open them to a flood of angry letters, phone calls and e-mail from divorced members seeking broad changes and from former spouses who want change too and also to preserve gains achieved with passage of the USFSPA.

Under the law’s so called 20-20-20 rule, a former spouse must have been married at least 20 years to a member who served at least twenty years, and at least 20 years of the marriage must overlap with the period of military service. Only 20-20-20 spouses continue to receive full benefits after they divorce.

 In a 2001 report to Congress, the Department of Defense called the 20-20-20 rule too restrictive but suggested only a modest change.  Perhaps, officials said, a former spouse should be able to count marriage time after the member retires as qualifying toward retaining full benefits. If so, there still should be at least a 15-year overlap of marriage and service time before retirement, the report said. Congress hasn’t made any change to the 20-20-20 rule. – T.P.

RELYING ON TRICARE

I thoroughly enjoyed the recent article on the TRICARE fees being blocked, at least temporarily. I am a retired Air Force technical sergeant (E-6) and times can be tight. My wife had two back surgeries three years ago and if it wasn't for TRICARE, I am not sure what we would have done. 

I put 20 years in the Air Force and at enlistment their promise of medical coverage was a huge item. Now being in one income family it is hard at times. I would love to switch over to my company health care plan but the cost is too prohibitive. I make roughly $45,000 a year and they want to take $350-$400 biweekly for healthcare. I cannot afford that!

In the event TRICARE fees are raised in the future, hopefully they would be more realistic than proposed.

Why take it out of our pockets anyway? We fulfilled our contracts yet we are always the first ones to get cut. I am sure there other places money can be found other than taking it from retirees who some have nowhere else to get their medical coverage.

JAMES P. MCCROSSON
Galloway, N.J.

Letters may be edited for clarity or length. Write to Military Forum, P.O. Box 231111, Centreville, VA  20120-1111, send e-mail to militaryforum@aol.com or visit www.militaryupdate.com

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