TRICARE For Life (TFL) Pharmacy Pilot Program

Our pharmacists have put this info together so that TFL beneficiaries can have a full picture of this unfortunate program that is being forced upon many of our customers.  Some TFL beneficiaries will be notified they have ZERO choice where to fill some medications as of March 14, 2014.  THERE IS A WAIVER AVAILABLE TO THIS PROGRAM, PLEASE SEE BELOW FOR MORE INFORMATION.        

First of all, we stand firmly on the side of TRICARE beneficiaries and subscribers of every other insurance plan, to be able to CHOOSE the pharmacy they use based on service, convenience, and personal relationships with pharmacists and other team members.  Independently owned retail pharmacies have for years now faced an unfair marketplace in which Pharmacy Benefit Managers (PBMs) can set a tilted copay and contract structure that coerces customers to use their company owned mail order pharmacies.  That is what is happening in the case of TRICARE.  Express Scripts is the PBM that administers the TRICARE pharmacy benefit, and they have tilted copay structures that steer beneficiaries to use their own Express Scripts Mail Order Home Delivery service.  We have nothing against Express Scripts or any other PBM competing for business IF it is done on an even playing field.  Having PBMs administer programs with taxpayer funds where the rules are set up differently for us than for them AND in their favor by way of different copay amounts is patently anti-competitive.  Again, some may find mail more convenient and in America that should be that customer’s choice.  However, coerced mail order, taken to a whole new level with this MANDATORY TFL pilot program, is clearly against the Federal Trade Commission’s declared strategic goals as posted on FTC.gov (our emphasis):

Protect Consumers: Prevent fraud, deception, and unfair business practices in the marketplace.

Maintain Competition: Prevent anticompetitive mergers and other anticompetitive business practices in the marketplace.

These coerced mail order programs are often sold to Congress under the guise of cost savings.  Who wouldn’t be for that?  Predictably, the official TFL Pilot program material from Express Scripts repeats this mantra:

Retail pharmacies are the most expensive option for

beneficiaries and the Department of Defense (DoD). Military

pharmacies and the home delivery option provide savings to

both beneficiaries and the government, supporting the DoD’s

efforts to control rising health care costs.

The evidence which shows that these coerced mail order programs do NOT save the government money is pouring in by way of CMS and other studies of the Medicare Part D program.

Mail Order Prices in Part D Often Higher Than Retail, CMS Concedes
Mail order pharmacies frequently charge Medicare prescription drug plans as much as 83% more than community pharmacies do for filling prescriptions, a new analysis by the Centers for Medicare & Medicaid Services has concluded.

"[T]his analysis has shown that negotiated pricing for the top 25 brands and 25 generics combined at mail order pharmacies is higher than at retail pharmacies for selected PDPs," CMS said. "Thus, our hypothesis that mail order negotiated prices are lower than retail pharmacy negotiated prices was not confirmed. Instead, we are finding higher prices at mail order than at retail pharmacies for some PDPs. CMS continues to be concerned about the impact of these prices on the Part D program."

The CMS analysis comes on the heels of an earlier 2013 study by the agency finding that prescriptions filled at "preferred pharmacies" sometimes result in higher costs to Medicare than prescriptions filled at non-preferred pharmacies, such as independent community pharmacies left out of the preferred network.

Earlier this year an independent analysis of millions of 2010 Medicare prescription drug event records found that community pharmacies provide 90-day medication supplies at lower cost than mail order pharmacies and that local pharmacists substitute lower-cost generic drugs more often when compared to mail order pharmacies.

These analyses don’t even include the massive waste that occurs with 90 day mail order autoship programs; click here for pictorial documentation.  This doesn’t happen at the pharmacy counter because of patient to pharmacist interactions; face to face.

For us, it always comes back to the customer in our work every day.  It turns out nearly 1,200 seniors have complained to Medicare this year about a litany of problems with mail order pharmacies, including shipping unneeded medication and going without medication due to delayed shipments, according to documentation recently released by the Centers for Medicare & Medicaid Services.

So, if it doesn’t save the government any money, creates massive waste, and is not liked by Medicare beneficiaries…why are we rolling out a mandatory mail program to TFL beneficiaries?  Why are coerced mail programs allowed to begin with?  Why not have PBM owned mail order pharmacies compete for business on an even playing field with brick and mortar (and pestle J) (sorry a little pharmacist humor) community pharmacies?  We would really like to know.

What can you do?

The TFL Pilot program is supposed to only involve brand name/non-generic drugs.  The list of affected drugs is available here. The first option is to visit with your doctor and/or pharmacist to inquire about a generic alternative to any medications on this list that you may be taking.

 There is also a waiver to get relief from this TFL Pilot Program:

Qualifying for a Waiver

In some scenarios, you may qualify for a waiver from participating in the Pilot:

·         Emergency

·         Personal needs

·         Special circumstances, such as living in a nursing home.

When You Get a Waiver

·         You can continue to fill your prescriptions at network pharmacies without penalty. 

·         Waivers are granted on a case-by-case basis.

To Request a Waiver

·         You or your caregiver can call Express Scripts at 1-877-363-1303.

·         To protect your privacy, a person calling on your behalf must provide the sponsor’s ID number, your name, date of birth, address, and telephone number. 

For those on our Medicine-On-Time packaging service or our customers in long term care facilities, this is the best way to continue using this free value added service we take pride in delivering to our community.  Of course they cite personal needs as well, so any reason you can provide to explain why doing business here is more convenient should be accepted.  Whether it is because of a pharmacist relationship, convenience, or anything else we would hope it would be honored.

The other important action is to engage our legislators.  We have been in touch very recently at the Senate and House level with Patty Murray and Rick Larsen’s offices.  They are aware of the issue and have advised that the more feedback we can provide the better.  ESPECIALLY, if you are denied a waiver.  We would like to help facilitate these communications about your objections to this program via the following mediums:

·         Social Media

o   Our facebook page www.facebook.com/laconnerdrug

o   Our twitter feed www.twitter.com/laconnerdrug

o   PLEASE USE THE HASHTAG #tflisldrg  (as in TFL Island Drug) so we can collect all the posts

·         Email your feedback to tflisldrg@laconnerdrug.com (as in TFL Island Drug)

·         Mail or drop of any hand or type written letters to any of our pharmacists.

In summary, we are proud to service those who have served our country and are equally as proud to be part of this military community with NASWI.  It is staggering to witness that those who bravely served to protect our freedom now are losing the freedom to walk into a community pharmacy to get a prescription filled.  All we are advocating for is that all customers have an honest choice as to where they fill prescriptions.  With your help, we can work together to fight coerced mail order programs.

Thank you for reading.