Does anyone know why Tricare pharmacy co-pays are going up again?

2016-01-11T09:49:58-05:00

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/

Tricare pharmacy co-pays to rise Feb. 1

Prescription co-payments will increase for some Tricare beneficiaries starting Feb. 1.

Response by MAJ Ken Landgren made Jan 11 at 2016 9:56 AM

2016-01-11T09:56:17-05:00

We are in an era where they take back more benefits.

Response by SFC Wade W. made Jan 11 at 2016 10:07 AM

2016-01-11T10:07:09-05:00

This is tied to Obamacare. New pharmaceutical policies.

Response by LTC Private RallyPoint Member made Jan 11 at 2016 10:34 AM

2016-01-11T10:34:26-05:00

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.

Response by CSM David Heidke made Jan 11 at 2016 12:03 PM

2016-01-11T12:03:25-05:00

So you can pay for the uninsured...

Response by Cpl Private RallyPoint Member made Jan 11 at 2016 4:08 PM

2016-01-11T16:08:14-05:00

Obamacare! Any questions?

Response by SCPO Private RallyPoint Member made Jan 12 at 2016 11:13 AM

2016-01-12T11:13:03-05:00

Mine are still zero, as they have always been.

Response by Capt Elizabeth Farrell made Jan 12 at 2016 7:45 PM

2016-01-12T19:45:32-05:00

The administrative pain associated with getting name brand medication for chronic conditions not on formulary is ridiculous. I'm retired and have to go through the special order process on base for prescriptions because the medication is not available through the mailorder pharmacy and I have to pay full price to use a retail pharmacy (currently $83 per month). My PCM is submitting special order requests for 3-month supply without refills. Therefore every 3 months its the same painful process for medication that is a medical necessity. Very frustrating!

Response by Maj Kim Patterson made Jan 13 at 2016 3:31 AM

2016-01-13T03:31:36-05:00

Col Joseph Lenertz New medications are being added to the formulary that are still in the patented stage and fairly costly (understatement) so my thought is may be attempting to share the cost across the board. There are many drugs you can get cheaper at the Wal-Mart or Kroger or Safeway or whatever is in your area. Many generics go for $4. Service connected medical needs are covered with no copay at the VA BUT non-service connected are currently $8 for a 30 day supply. Order 90 at a time, the charge is $24. I just opened a bill today.

Response by PO2 Nathan Meyer made Jan 13 at 2016 2:14 PM

2016-01-13T14:14:46-05:00

Express scripts raised all of the copays for everyone; not just tricare. It's stupid because last year it was raised from $5 to $8. Considering a good bulk of the tier 1 drugs are oddly expensive, I am not too surprised by the move.

Response by Sgt Aaron Kennedy, MS made Jan 14 at 2016 6:05 AM

2016-01-14T06:05:23-05:00

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.

Response by COL David Petray made Apr 8 at 2016 7:34 AM

2016-04-08T07:34:22-04:00

Two reasons: 1. to offset increasing costs to the program; and, 2. to encourage you to use the mail order or military treatment facility options (which are much cheaper to the Government). If you use retail pharmacy (CVS, Giant, Target, etc..) for chronic medications (refills every month) you are costing the government much more than the same prescription filled at the mail order or military treatment facility so the TRICARE folks, with the help of Congress, is going to keep raising co-pays until you stop using retail! I'm in the same boat. I finally gave up and went mail order. It works, mostly. Not as convenient as stopping by my local CVS drive through on the way home.