TRICARE to go mail order

[fauxden]

Advertisement - Members don't see this ad

"TRICARE will cut co-payments from $3 to zero for a 90-day supply of formulary generic drugs, effective Oct. 1. NCPA and the National Association of Chain Drug Stores continue to lobby for a more even-handed approach with a much greater emphasis on increasing the generic drug dispensing rate, regardless of where a prescription is dispensed. NCPA has met with senior officials at the Department of the Defense, veteran's groups, and members of Congress urging them not to support eliminating choice for soldiers and their families. If these co-pay changes affect your business and patients, please contact your representative and senators.
Increasing the use of generic drugs is a proven cost saver, and community pharmacies dispense generics 72% of the time—significantly higher than mail order. IMS Health estimates that in the Medicaid program just a 1% difference in generic dispensing rates can produce $500 million in savings nationally. Other scheduled co-pay changes will also make it more expensive for TRICARE beneficiaries patronizing their community pharmacy. They include:

• Co-pays for generic formulary drugs purchased at community pharmacies will increase from $3 to $5.
• Brand name formulary drug co-pays at community pharmacies will go from $9 to $12.
• Nonformulary drug co-pays will go from $22 to $25 in both community and mail order.

Mail order brand name formulary drugs will have the same $9 co-payment. Co-payments for prescriptions filled through mail order cover a 90-day supply, but only a 30-day supply when purchased at a community pharmacy."

Great....

 

[Pharmizzle]

I believe it's been cheaper for them to use TMOP for awhile now. We were always told to explain it to our patients like this:
Co-payments across the board for Tricare were $3 for generics, $9 for brand for up to a 30 day supply at a community pharmacy (obviously what they got from the base pharmacy was free, so this was the spiel we had to give if it was a drug we didn't stock). So if a patient got a 90 day supply at a community pharmacy, they would pay $9 for generics ($3/month) or $27 for brand ($9/month). If they used TMOP, they could get a 90 day supply for one co-payment, so up to 90 days for $3 or $9 (or $22 for non-formulary drugs).

I never used mail order or a community pharmacy myself, but I also never had a patient come back and tell us it was wrong, but someone who deals with Tricare in retail a lot could shed some light on that for me.

According to the Tricare site, the old co-pays were:
Current Copays
Retail Network Pharmacy
(up to a 30-day supply)$3 $9 $22

New co-payments for retail are:
Copays Effective October 1, 2011
Retail Network Pharmacy
(up to a 90-day supply)$5 $12 $25

If I'm reading that correctly, that's actually less expensive than before, although still more expensive than the mail order.

http://www.tricare.mil/faqs/

It is unfortunate for situations like antibiotics though, because a patient can't exactly mail those off and wait for them and they'll now be paying $5 instead of $3 for however many days of therapy.

EDIT: Also, for what it's worth, the base I was stationed at served as a test site for using mail-order for refills, with the intention of making all refills mandatory mail-order-only if it was popular. They dropped that idea because only about 15% of our patient population opted to use it, and that was with NO co-pays for any of them.

 

[CUninja]

What that article fails to mention is that on base the meds are free.

So how is this eliminating choice? Patients can pick up in person on base or go mail order if they don't want to pay. This is not forcing mail order down a patient's throat. (dont mean this to be mean by this 🙂 )

What this comes down to is that it will reduce the off base scripts at chains such as Walgreens/CVS, etc which is why the NCPA is against it. These scripts cost the DoD more than on base/mail order does.

If a patient REALLY wants to go to an off base chain - a $3 raise in copay is not going to stop them.

And - it is a 30 day supply for retail - 90 day supply for mail order. FYI

 

[type b pharmD]

Perhaps major news in the pharmacy benefits world, not so much in the community pharmacy world. Thread title seems overdramatic to me. It's just a simple shifting of incentive , and honestly, are a lot of avg Americans going to be motivated to change the way they are doing things because of a few bucks a month ? You'd have to be on a VERY restricted fixed income to *need* to switch to mail order. I agree it's bad, but this is not the disaster news for retail that a mandatory mail order program would be, which seems to have been implied by the OP . Imho

 

[Jbuprepharm]

using TMOP or MTF pharmacies saves the DoD anywhere from 25-50+% over retail.

therefore, it saves you, the taxpayer, money as well (or allows it to be spent elsewhere)

I understand it takes away some business from the retail chains, but it can save the gov millions every year. Hey, we're supposed to cut spending right?

 

[R2pharmD2]

What that article fails to mention is that on base the meds are free.

So how is this eliminating choice? Patients can pick up in person on base or go mail order if they don't want to pay. This is not forcing mail order down a patient's throat. (dont mean this to be mean by this 🙂 )

What this comes down to is that it will reduce the off base scripts at chains such as Walgreens/CVS, etc which is why the NCPA is against it. These scripts cost the DoD more than on base/mail order does.

If a patient REALLY wants to go to an off base chain - a $3 raise in copay is not going to stop them.

And - it is a 30 day supply for retail - 90 day supply for mail order. FYI

👍

The title of this thread is misleading (at best).

Also, a link to the original article by the OP would be great.

 

[Ackj]

What this comes down to is that it will reduce the off base scripts at chains such as Walgreens/CVS, etc which is why the NCPA is against it. These scripts cost the DoD more than on base/mail order does.

If a patient REALLY wants to go to an off base chain - a $3 raise in copay is not going to stop them.

I don't think there are too many on active duty who will leave base just to go get an rx filled. This is probably more of an issue for reserves or those on leave, because you probably won't be running back to base in those cases. Also for your family members, I don't know if your wife and kids are going to come up to the base for an rx.

 

[Caverject]

I don't think there are too many on active duty who will leave base just to go get an rx filled. This is probably more of an issue for reserves or those on leave, because you probably won't be running back to base in those cases. Also for your family members, I don't know if your wife and kids are going to come up to the base for an rx.

You'd be surprised...think about it...If you have a hard copy prescription, why would you want to spend an hour waiting for an rx when you can drop it off at the drive thru and pick it up later for the same copay? (which is $0.00)

 

[Caverject]

I believe it's been cheaper for them to use TMOP for awhile now. We were always told to explain it to our patients like this:
Co-payments across the board for Tricare were $3 for generics, $9 for brand for up to a 30 day supply at a community pharmacy (obviously what they got from the base pharmacy was free, so this was the spiel we had to give if it was a drug we didn't stock). So if a patient got a 90 day supply at a community pharmacy, they would pay $9 for generics ($3/month) or $27 for brand ($9/month). If they used TMOP, they could get a 90 day supply for one co-payment, so up to 90 days for $3 or $9 (or $22 for non-formulary drugs).

I never used mail order or a community pharmacy myself, but I also never had a patient come back and tell us it was wrong, but someone who deals with Tricare in retail a lot could shed some light on that for me.

According to the Tricare site, the old co-pays were:
Current Copays
Retail Network Pharmacy
(up to a 30-day supply)$3 $9 $22

New co-payments for retail are:
Copays Effective October 1, 2011
Retail Network Pharmacy
(up to a 90-day supply)$5 $12 $25

If I'm reading that correctly, that's actually less expensive than before, although still more expensive than the mail order.

http://www.tricare.mil/faqs/

It is unfortunate for situations like antibiotics though, because a patient can't exactly mail those off and wait for them and they'll now be paying $5 instead of $3 for however many days of therapy.

EDIT: Also, for what it's worth, the base I was stationed at served as a test site for using mail-order for refills, with the intention of making all refills mandatory mail-order-only if it was popular. They dropped that idea because only about 15% of our patient population opted to use it, and that was with NO co-pays for any of them.

You forgot that all generic drugs via mail-order will now have a $0.00 copay...

 

[Pharmizzle]

You forgot that all generic drugs via mail-order will now have a $0.00 copay...

How did I forget? As I noted, when we did our mail order test site, not many people used it, even though all Rxs, brand AND generic, had $0 co-pays. I didn't mention it explicitly because my point was that the retail option has always been more expensive than the mail order option, and both options have always been more expensive than going to base, which is free.

 

[Doctor M]

We do not fill any Tricare at all. So,will not really affect us in terms of losing business.

 

[Caverject]

We do not fill any Tricare at all. So,will not really affect us in terms of losing business.

I didn't know you were anti-military! J/k

 

[Caverject]

How did I forget? As I noted, when we did our mail order test site, not many people used it, even though all Rxs, brand AND generic, had $0 co-pays. I didn't mention it explicitly because my point was that the retail option has always been more expensive than the mail order option, and both options have always been more expensive than going to base, which is free.

Were you at wright Patterson?

 

[Doctor M]

I didn't know you were anti-military! J/k

Ha! My Business partner is Navy!

 

[CUninja]

I don't think there are too many on active duty who will leave base just to go get an rx filled. This is probably more of an issue for reserves or those on leave, because you probably won't be running back to base in those cases. Also for your family members, I don't know if your wife and kids are going to come up to the base for an rx.

I know Cav already posted an answer to this but this seemed like the perfect time to use this image...👍
I apparently like pictures of what appear to be stuffed owls....and that, my friends, is the sound of this thread being derailed..

 

[owlegrad]

I know Cav already posted an answer to this but this seemed like the perfect time to use this image...👍
I apparently like pictures of what appear to be stuffed owls....and that, my friends, is the sound of this thread being derailed..

I don't know how to address this. I am pro owle, but I don't know what to say about the practice of taxidermy. My gut tells me I am against it.

 

[Ackj]

You'd be surprised...think about it...If you have a hard copy prescription, why would you want to spend an hour waiting for an rx when you can drop it off at the drive thru and pick it up later for the same copay? (which is $0.00)

Never having been on a base, to experience that, I don't quite follow. Would the "spend an hour waiting" refer to the base, where it's free? As I'm reading, the drive thru would be any chain, but they aren't going to have $0 copay there. I must be misreading something. Or are you talking about how it is now, before the change OP is talking about?

The first few posts make me think: Base = free, go to a chain = pay, mail order = pay less. Is this right?

 

[aboveliquidice]

Never having been on a base, to experience that, I don't quite follow. Would the "spend an hour waiting" refer to the base, where it's free? As I'm reading, the drive thru would be any chain, but they aren't going to have $0 copay there. I must be misreading something. Or are you talking about how it is now, before the change OP is talking about?

The first few posts make me think: Base = free, go to a chain = pay, mail order = pay less. Is this right?

Wait time at a busy MTF pharmacy is a lot longer than the local CVS or wags. Not sure how the free generic mail order decision will weigh into the cost reduction. I guess we'll see what happens.

 

[Caverject]

Never having been on a base, to experience that, I don't quite follow. Would the "spend an hour waiting" refer to the base, where it's free? As I'm reading, the drive thru would be any chain, but they aren't going to have $0 copay there. I must be misreading something. Or are you talking about how it is now, before the change OP is talking about?

The first few posts make me think: Base = free, go to a chain = pay, mail order = pay less. Is this right?

Copays are $0.00 at retail chain for service members...