Posted on Jan 11, 2016
Does anyone know why Tricare pharmacy co-pays are going up again?
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I know the law is linked to COLA, but COLA increased by zero this year. So why are co-pays going up 25% (generic) and 20% (brand name) for a year with no COLA increase? How is it computed?
http://www.militarytimes.com/story/military/benefits/health-care/2016/01/10/tricare-pharmacy-co-pays-rise-feb-1/78354998/
http://www.militarytimes.com/story/military/benefits/health-care/2016/01/10/tricare-pharmacy-co-pays-rise-feb-1/78354998/
Retirement
Benefits
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Edited 10 y ago
Posted 10 y ago
Responses: 10
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Sir, Simply put this is an "incentivized scheme" to reward/punish specific behavior.
The GOAL is to shift people "out of the RETAIL" system into the "Home Delivery" or "Dispensary" (VA) system.
If you are using RETAIL system, or NAME BRAND medications, you will see price increases. If you are using the "home delivery" method, the pricing will remain the same. "In theory" this will reduce the Administrative and Overhead Cost for Retirees and Veterans in the "long run" as they will be better able to forecast specific medicine & pharmaceutical needs.
Medicine is essentially a "commodity" like Oil, Orange Juice (Think Trading Places with Eddie Murphy), or Pork Futures. When you are buying "short term" the Government ends up paying significantly more. Therefore, they are offsetting losses at the RETAIL side by increasing the CO-PAY & Name Brand drugs by 20%. However, using the dispensary (aka Home Delivery) system, they can leverage long term sales data to purchase quarters in advance to reduce cost to the government.
It's "shifting cost" from one side to the other. Short Term increase (punishment) pays for Long Term overhead (reward).
Make sense?
As an example, I take 2 meds. Topiramate (2/day 100mg) and Sumatriptan (100mg as needed). If I were to use a standard $15.00 CO-PAY (made up number) for a 30 day prescription for the generics, they can forecast my need for years. However, if I go to a RETAIL like Target, the WASTE becomes pure overhead and loss for the government, especially if using the "Named Brand" variants of Topamax and Imitrix resp. So... they make those more expensive by 20%/25% AND give me 90day refills. Basically rewarding me for using the "less convenient" system, which has a significant cost advantage to the government.
The GOAL is to shift people "out of the RETAIL" system into the "Home Delivery" or "Dispensary" (VA) system.
If you are using RETAIL system, or NAME BRAND medications, you will see price increases. If you are using the "home delivery" method, the pricing will remain the same. "In theory" this will reduce the Administrative and Overhead Cost for Retirees and Veterans in the "long run" as they will be better able to forecast specific medicine & pharmaceutical needs.
Medicine is essentially a "commodity" like Oil, Orange Juice (Think Trading Places with Eddie Murphy), or Pork Futures. When you are buying "short term" the Government ends up paying significantly more. Therefore, they are offsetting losses at the RETAIL side by increasing the CO-PAY & Name Brand drugs by 20%. However, using the dispensary (aka Home Delivery) system, they can leverage long term sales data to purchase quarters in advance to reduce cost to the government.
It's "shifting cost" from one side to the other. Short Term increase (punishment) pays for Long Term overhead (reward).
Make sense?
As an example, I take 2 meds. Topiramate (2/day 100mg) and Sumatriptan (100mg as needed). If I were to use a standard $15.00 CO-PAY (made up number) for a 30 day prescription for the generics, they can forecast my need for years. However, if I go to a RETAIL like Target, the WASTE becomes pure overhead and loss for the government, especially if using the "Named Brand" variants of Topamax and Imitrix resp. So... they make those more expensive by 20%/25% AND give me 90day refills. Basically rewarding me for using the "less convenient" system, which has a significant cost advantage to the government.
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Sgt Aaron Kennedy, MS
Col Joseph Lenertz It's confusing to say the least, especially since no one really explains the logic behind it. It's just assumed that we know, but it actually creates more resistance than compliance.
If the powers that be put out a factsheet that said "long term savings" by using Mail Order vs. Retail and PROMINENTLY displayed it for the first year of the program the entire "shrinking benefits" argument shifts to a "preserving funds."
If the powers that be put out a factsheet that said "long term savings" by using Mail Order vs. Retail and PROMINENTLY displayed it for the first year of the program the entire "shrinking benefits" argument shifts to a "preserving funds."
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Sgt Aaron Kennedy, MS
MCPO Roger Collins - I try. I just don't like being confused, and I happened to have encountered this previously dealing with the VA side of it.
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Sir, my conspiracy theory is that they are trying to phase out Tricare and force the military into the Affordable Healthcare Act.
It would make sense at this point, and provides the ailing priority an influx of new members. That of course will not pull it out of the red.
Whether or not my theory is correct remains to be seen, but it would be in line with the other changes taking shape, including the retirement changes which harm junior enlisted and officers as opposed to helping them save for retirement.
Of course, the face value answer is that this is all due to costs associated with big-pharma, which again is a trickle down-effect of the AHCA.
It would make sense at this point, and provides the ailing priority an influx of new members. That of course will not pull it out of the red.
Whether or not my theory is correct remains to be seen, but it would be in line with the other changes taking shape, including the retirement changes which harm junior enlisted and officers as opposed to helping them save for retirement.
Of course, the face value answer is that this is all due to costs associated with big-pharma, which again is a trickle down-effect of the AHCA.
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LTC (Join to see)
MCPO Roger Collins - Got on that topic as I had mentioned it in my original post as one more way the government is, for lack of a better word, shafting Soldiers. Scroll to the top of this thread...
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MCPO Roger Collins
CW4 Guy Butler - Is it for formulary or generic? As I stated earlier, the only co-pays my wife or I have is for those prescriptions that are not generic. Even then it a pittance when you think it is for 90 days. BUT, I only use ExpressScripts for my prescriptions, unless there is a problem at the mail order house on a one shot thing.
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