[HEALTH.MIL] Bigger Prescription Fees, Free Vaccines and the CRSC 'Glitch" Fix

  • From: HEALTH.MIL@xxxxxxxxxxxxx
  • To: <TFL@xxxxxxxxxxxxx>, <HEALTH.MIL@xxxxxxxxxxxxx>
  • Date: Thu, 13 Dec 2012 16:13:12 -0600

Bigger RX Fees, Free Vaccines and the CRSC 'Glitch" Fix
By Tom Philpott
Published: December 13, 2012

Defense Secretary Leon Panetta has urged House-Senate conferees negotiating a
final details of the 2013 defense authorization bill to support the Obama
administration's "full proposal" for hiking drug co-pays on military family
members and retirees.

[Defense Secretary Leon Panetta has urged House-Senate conferees negotiating a
final details of the 2013 defense authorization bill to support the Obama
administration's "full proposal" for hiking drug co-pays on military family
members and retirees.]

The higher fees, which would nearly triple out-of-pocket costs for brand-name
prescriptions at TRICARE retail outlets, are to encourage greater use of less
costly options - the TRICARE mail order program and base pharmacies, Panetta
explained.  He did so in a Dec. 11 letter to Rep. Howard "Buck" McKeon, chairman
of the House Armed Services Committee.

The Senate-passed defense bill, by staying silent on the pharmacy issue, would
allow TRICARE officials to carrying out their plan to raise beneficiary co-pays
at retail outlets over several years and then to adjust them annually to keep
pace with medical inflation.  Part of that plan is to raise the current $12
co-pay on brand name drugs filled at TRICARE network drug stores to $26 in 2013
and to $34 by 2016.

House bill language, if adopted, would soften that blow.  It would allow the
brand name co-pay at retail to climb only to $17 next year and then adjust it
thereafter by the percentage increase in retired pay annually.  But the House
plan also would require beneficiaries 65 and older to have all maintenance drugs
for chronic conditions filled by mail order only.

Referring to "spiraling health care costs," Panetta told McKeon the department
"is pleased" to see that either bill will "permit some increases in
pharmaceutical co-pays" to save money "by providing incentives to use mail order
and generic drugs."  Most of the savings, he said, would not come from
beneficiaries but from greater use of more efficient pharmacy choices.

FREE VACCINES -- While conferees press to reach compromise on drug co-pays, Rear
Adm. Thomas McGinnis, chief of TRICARE pharmacy operations, is urging
beneficiaries, especially the elderly, to take advantage of a line of cost-free
drugs at TRICARE retail outlets: vaccines.

It used to be a hassle to get a flu shot or vaccine for shingles or other
preventable ailments.  Patients needed a doctor's appointment and often faced a
co-payment.  The process today is easy and cost-free through TRICARE retail
outlets but many beneficiaries don't know this, McGinnis said.

Retail druggists are primed to offer vaccines, in part, because they get paid
for supplying the medicine and for administering the shot.  The higher cost to
TRICARE, McGinnis said, is more than offset by savings from preventing common
illnesses.  Vaccines mean fewer doctor visits and fewer medicines dispensed for
ailments now avoided.

"If flu is prevented you don't need to get an office appointment with your
primary care manager.  You don't need an antibiotic or antihistamine or some
other drug.  The direct cost savings are substantial because these vaccines are
cheap and very cost effective," McGinnis said.  Then there are the indirect
costs of military folks not missing work.

Vaccines given on base are still the most cost-effective for TRICARE. But the
retail network began offering them in November 2009, and since then more than
707,000 beneficiaries have received almost 1.1 million vaccines off base.  About
910,000 of them were for seasonal flu and 120,000 to prevent shingles.  Others
protected against pneumonia, herpes, meningitis, diphtheria, pertussis and

"We wanted to expand the number of outlets where beneficiaries could get
vaccinated," said McGinnis.  "This was at the time when the pharmacy community
was just starting to get authority from state boards of pharmacies to administer

Congress in 2010 made it more attractive to get vaccines at their local druggist
by giving TRICARE permission to provide them at no charge.

"That's what we really latched on to, especially in small towns where the
pharmacist knows all the customers.They are incentivized to get more of these
done and that's a good thing," McGinnis said.

Though TRICARE last month passed the one million mark for vaccines at retail
outlets, McGinnis said "that number probably should be much higher because many
beneficiaries don't live close to military treatment facilities."  They need to
know, he said, "that this is convenient, easy and free."

CRSC "GLITCH" - A key issue conferees on the defense bill are considering is the
fate of a Senate-passed fix to a "glitch" in Combat-Related Special Compensation
(CRSC) for some military retirees forced from service short of 20 years due to
combat-related conditions. 

Congress in 2008 extended CRSC eligibility to so-called Chapter 61 retirees with
combat-related disabilities.  But the calculation formula approved for the CRSC
extension leads, in some circumstances, to little or no additional CRSC due when
a retiree's disability rating rises.  Whether an individual is impacted, and by
how much, by this glitch depends on several factors including original service
disability rating, length of service, VA rating and CRSC rating tied to a
member's combat-related condition.

After years of trying, Sen. Harry Reid (D-Nev.), the majority leader, saw his
amendment to correct the glitch adopted last week in the Senate version of the
defense bill.  If House conferees accept it, retirees uniquely impacted by the
glitch would see CRSC increase starting Oct. 1, 2013.  Reid couldn't find a
budget offset to make the change any sooner.

Thomas LaRock, a spokesman for the Defense Finance and Accounting Service, said
the number of retirees impacted by the glitch is hard to estimate given the
complexity of calculations required.  But it could be dampening pay an average
of a few hundred dollars a month for as many as 5000 to 6000 retirees, he said.
That estimate of the population impacted is expected to fall as individual case
files are examined.

Officials with Military Officers Association of America, which began to lobby
for a CRSC fix four years ago, said some retirees probably aren't even aware
their compensation has been held down by a flawed formula.

Write Military Update, P.O. Box 231111, Centreville, VA, or email
milupdate@xxxxxxx or Twitter: @Military_Update

SOURCE:  Stars and Stripes article at http://www.stripes.com/news/americas/

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