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

Retirees Approach Mail Order Drugs With Caution

I understand there is a push to mandate that retirees on maintenance medicines use TRICARE mail order prescription program.

I've stopped using that service because twice in the past, when I sent in a prescription, I got a call telling me the medicine was not available and they didn't know when they would get it. Then, instead of sending the prescription back to me so I could get it filled at my local pharmacy, they sent it back to my doctor who didn't get it for two weeks.

This is good service?

I have congestive heart failure, failing kidneys, emphysema and atrial fibrillation for which I take medication. Having to depend on mail service is dangerous. Hopefully, the Department of Defense will think twice about what they are proposing.

PETER K. SPONGBERG

USN-Ret.
Via e-mail

I have been using the TRICARE mail order pharmacy for better than one year. It works well. There is no reason for anyone to use retail pharmacies for maintenance medications.

As a TRICARE beneficiary I do have a responsibility to keep costs as low as possible. TRICARE is a great benefit. We need to work together to keep the benefit and reduce costs.

FRANK O’DONNELL
Lieutenant Colonel, AUS-Ret
Holland, Pa.

What seems to be lost in all this pressure to use the mail-order pharmacy is the service that local pharmacists give in identifying interactions between various prescribed medications. In most cases, they are a better source than prescribing physicians.

A family member is required to use Coumadin, a blood clotting inhibitor. Our local pharmacist has many times been able to warn us of possibly dangerous side effects when used with other medications. This is a service that the mail-order pharmacy cannot provide.

LOU LEVY
Lieutenant Colonel, USAF-Ret.

Not true, according to TRICARE pharmacy officials.

Rear Adm. Thomas J. McGinnis, USPHS, the officer in charge of TRICARE pharmacy operations, said, “Patient safety is paramount in TRICARE pharmacy services. Registered pharmacists check each patient's medication history regardless of where he or she has filled prescriptions -- military treatment facility, retail pharmacy or mail-order -- to avoid potentially adverse drug interactions. Beneficiaries choosing the mail-order option who have questions may speak to a pharmacist 24 hours a day using a toll-free phone number. The following link has more information about mail order (see safety area): http://www.tricare.mil/pharmacy/tmop_whyuse.cfm. Here also is a link for information on the patient medication database: http://www.pec.ha.osd.mil/pdts.htm

Last June I started trying to get my 10 mg Lipitor prescription by mail order. In November, I finally got from Express Scripts a substitute, Zocor.

By mid-December I was suffering severe muscle weakness. I quit taking Zocor and the muscle weakness subsided significantly.

Though in early January I still had some muscle weakness, I got my heart doctor to again send to Express Scripts a prescription for Lipitor. Two weeks later I finally received Lipitor.

All of this does not bode well for the mail order program’s obscurity. The issues are:

1) Complexity of applying. Why couldn't I just send them my prescription and service number, and let them determine if I am eligible, the same way the local pharmacy does?

2) The unavailability of a drug I had been taking for several years. It would have been all right for them to suggest that an alternative likely would be better or cheaper -- after they filled the prescription.

3) Lack of concern for problems that switching drugs can cause, particularly statins which are cholesterol-lowering drugs. In trying to determine what might be causing my muscle weakness, my research led me to believe I was flirting with a life-threatening situation.

Hopefully my experience is unusual. But it scares me to think of TRICARE coercing great numbers of people to use mail order since that will likely bring on more complacency and make matters worse.

Maybe some of this will help the Defense Department figure out a better way of saving money and still providing service on par with my local pharmacist.

RONALD SEAMAN
Major, USMC-Ret.
Via e-mail

My sister and I have tried to get Mom and Dad's meds via TRICARE mail order. The system is cumbersome to navigate. We gathered prescriptions from the urologist, the glaucoma specialist, primary care specialists and two neurologists only to learn that most of their prescribed medicines were not available. That includes three of Dad's long term use meds for glaucoma and two of Mom's Alzheimer's meds. Only two medicines were available by mail order and it wasn't worth the red tape.

MARTHA ROPER
Glendale, Ariz.

Generic drugs do not always react the same as the “name brand” drugs they replace. I have had mixed success with generic drugs.

DENNIS HACKNER
Via e-mail

Generic drugs, by definition, are supposed to be chemically identical to brand name drugs. They also must meet the same Food and Drug Administration standards for safety, purity and effectiveness. – Tom Philpott

WHY THE DISPARITY?

Regarding Defense Department plans to raise TRICARE fees, I do not agree with paying more for the same coverage because I'm a retired officer.

I started out as enlisted and worked my way up through the ranks. I did not do that so I can pay out more money for medical coverage. That is discrimination in its purest form to me.

TRICARE cost increases should be similar across the board.

JOSEPH A. ALDOUPOLIS
Lisbon Falls, Me.

NO SURGE

Selling a second round of deployments in Iraq to National Guard soldiers may not be difficult, according to Brig. Gen. James Nuttall, deputy director of the Army National Guard. But a different story would emerge with any objective journalism from Tom Philipott.

The majority of American people, the U.S. Senate and a growing number of soldiers are against the troop surge into Baghdad, against the war and want an immediate redeployment.

An easier sell would be to get out of Iraq. Now.

WAYNE JOHNSON
Honolulu, Hawaii

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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