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.