On 21 JUN, the DoD Beneficiary Advisory Panel (BAP) met to review DoD proposals to move certain cholesterol, prostate, and blood pressure medications to the third tier, or $22 copay level. They also re-reviewed some acid reflux drugs that were originally evaluated in 2005. Proposals included: - To move cholesterol drugs Tricor, Antara, Omacor, and Welchol to the third tier. Six cholesterol medications will remain on the formulary at $3 or $9 copays. In order to persuade beneficiaries to use Triglide, a low-cost brand-name drug, DoD is proposing to lower the $9 copay to $3. - To move prostate drug Avodart to the third tier, leaving the generic Proscar on the formulary for $3. - Re-evaluating certain acid reflux medications that were originally reviewed in FEB 05. At the time, they moved multiple drugs, including Nexium, to $22, based on their relative high cost. Now, DoD has gotten a reduced price on Nexium and proposes to reduce its copay all the way down to $3, even though it's not a generic drug. However, DoD is proposing to put a "prior-authorization" requirement for this class of drugs, requiring beneficiaries to try either Nexium or Prilosec before being authorized to use other drugs in the same class. Current prescriptions for the other acid reflux drugs would be grandfathered at $22. But future prescriptions wouldn't be covered for those drugs, even for the $22 copay, unless Tricare approves a doctor's statement that there's a medical necessity to prescribe them (e.g., because Prilosec and Nexium aren't effective or have adverse effects for the patient). - To move hypertension and chronic heart failure drugs Avapro, Avalide, Benicar, and Diovan to the third tier. This would leave Atacand, Cozaar, Hyzaar, and Micardis on the formulary at the lower copay.
MOAA's CDR John Class (USN-Ret), a member of the BAP convened to comment on the proposed changes, took the opportunity to reiterate concerns that beneficiaries using the affected drugs aren't being given adequate notification about either the copayment change or about which medications are still available for the lower copay. Since DoD doesn't notify beneficiaries at all, and doesn't allow military associations time to print the notices in their magazines, most beneficiaries do not find out about the changes until their pharmacist starts charging them $22 instead of the $9. Without an education program, they usually just grind their teeth and pay the $22, without being made aware of lower-cost alternatives. This insensitive process causes both the beneficiary and the government to pay far more than they need to since because the intended purpose of the copay increase (i.e. to cause beneficiaries to choose lower-cost medications) is unlikely to be realized. The beneficiary panel's concerns will be submitted to Dr. S. Ward Casscells, the new Assistant Secretary of Defense (Health Affairs), for final decision. For more information on these and other drugs, refer to the Tricare pharmacy web site www.tricare.mil/pharmacy/#. [Source: MOAA Leg Up 29 Jun 07++]