What Your Pharmacy Can Do About TRICARE Cuts
Posted by Emily Thompson on Sep 1st 2020
In May we saw compounding reimbursement take another blow as Tricare adopted Express Scripts’ “commercial reject list” for compound claims. But this really isn’t just about a struggle between pharmacies and insurance companies; this is about patients no longer being able to receive the prescriptions they need. TRICARE serves our active military, retirees, families, survivors and more. Cutting compounds from their covered services means, in many cases, men and women who have fought for our freedom and paid a high price doing so, are now being forced to pay a high price for their treatment as well. The prohibitive cost increase will cause patients to seek alternative treatment, typically in the form of opiate-based oral pain killers which may have serious side effects and can lead to addiction. This is not how we ought to care for our military. This is not how we take care of people.
BE A PART OF THE SOLUTION - What you can do:
1- Send a letter
- A personalized letter will be most effective, but the fact of the matter is that the average person will not take the time to write out their own letter. Acknowledging this reality, a standardized form en masse is better than no letter at all. Here is a sample letter to use – just replace with your name and contact information and sign at the bottom.
2- Get your patients involved!
THEIRS IS THE VOICE THAT NEEDS TO BE HEARD. When you are faced with the task of letting them know their prescription won’t be covered, empower them rather than discourage them. The average patient has no idea what these changes are, why they’re happening, or how to change it. All they know is they can’t get the treatments they need covered anymore.
- TRICARE patients can file a Pharmacy Appeal for coverage – the instructions are here.
- If their Pharmacy Appeal is not accepted, they can also file a Grievance here.
- While they’re there, have them fill out another letter with their name and address – it’s basically like signing a petition – you can even take care of mailing them all in together. That’ll make a statement!
- Patients can attend one of TRICARE’s monthly live webinars and are able to submit questions. There’s no guarantee that they will address them, but it still helps to get the message across. There is a webinar on June 19 th for TRICARE Pharmacy Options with CAPT. Edward Norton, Deputy Chief, Pharmacy Operation division in the Healthcare Operations Directorate of the Defense of Health Agency (DHA), which manages the Tricare Pharmacy benefit. This is a great opportunity to address him personally.
3- Use Social Media
- Get the word out! There is strength in numbers, get other pharmacies involved in speaking out and empowering their patients. Share a link to this page so they see their options.
4- Be Persistent
- It may not sound mature, but the squeaky wheel gets the grease. Show your support for compounding and its importance to healthcare in order to prompt Tricare and ESI to revise their recent and erratic compound management strategies.
As a Pharmacist, you are always seeking the best possible care and treatment of the patient. These are tangible ways you can help regain and protect their coverage both through your own advocacy and informing patients of the avenues they have of affecting change on their own.
Beyond this specific measure, the struggle for compound coverage is nothing new. There are groups like Save Rx Access and P3 that are specifically organized for the ongoing advocacy of compounding access. Check out their resources and join in their cause.
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