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/
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Edited >1 y ago
Posted >1 y ago
Responses: 11
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MAJ Ken Landgren
Sometimes stupid things happens as one pharmaceutical company was charging few dollars per prescription and arbitrarily increased to over $1000 per prescription, the company was eventually busted.
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GySgt Carl Rumbolo
MAJ Ken Landgren - The company wasn't 'busted' - the CEO was taken down for securities fraud related to another of the companies he was fronting - entirely different issue. Yes the obnoxious SOB did hike the price of a pill for a relatively rare disorder from 13.50 per pill to something like 5000 - if memory serves, don't feel like googling the exact number :)
Essentially the largest part of problem is Congress - a couple years back Congress prohibited medicare from using it's volume to negotiate pricing with drug companies (the Veterans Dept, Medicaid and the DOD can) - so Medicare takes a hit every year.
It's is just a larger symptom of how broken health care is in this country. My daughter worked as a certified medical billing coder - the price you pay for care depends on how it is coded, who your insurer are, or if you are not insured. Plus hospitals have no standard method of determining how much a procedure costs - the same MRI can cost X at an imaging center, X+10 at clinic and X+50 at the hospital - all under the same health care service provider. It's insane.
Drug costs in the US are insane - I made a business trip to India not all that long ago - the price of a common cholesterol drug was like 20 rupees - for 90 days supply, all you needed was a script - if you went to an Indian doctor with a US prescription and paid his fee, it was simple to get a year supply for a roughly 700-800 rupee including the hotel doctor visit (docs in hotels internationally are generally first rate) - depending on exchange rate that is roughly 30 dollars. That same year supply costs you roughly 1200 a year without co-pays.
Now of course getting the drugs back to the US can be an issue - Customs really frowns on it pretty seriously and it's against the law - the government has cracked down on mail-order pharmacy trade from Canada and other places - we pay the highest drug prices in the world.
Essentially the largest part of problem is Congress - a couple years back Congress prohibited medicare from using it's volume to negotiate pricing with drug companies (the Veterans Dept, Medicaid and the DOD can) - so Medicare takes a hit every year.
It's is just a larger symptom of how broken health care is in this country. My daughter worked as a certified medical billing coder - the price you pay for care depends on how it is coded, who your insurer are, or if you are not insured. Plus hospitals have no standard method of determining how much a procedure costs - the same MRI can cost X at an imaging center, X+10 at clinic and X+50 at the hospital - all under the same health care service provider. It's insane.
Drug costs in the US are insane - I made a business trip to India not all that long ago - the price of a common cholesterol drug was like 20 rupees - for 90 days supply, all you needed was a script - if you went to an Indian doctor with a US prescription and paid his fee, it was simple to get a year supply for a roughly 700-800 rupee including the hotel doctor visit (docs in hotels internationally are generally first rate) - depending on exchange rate that is roughly 30 dollars. That same year supply costs you roughly 1200 a year without co-pays.
Now of course getting the drugs back to the US can be an issue - Customs really frowns on it pretty seriously and it's against the law - the government has cracked down on mail-order pharmacy trade from Canada and other places - we pay the highest drug prices in the world.
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Sgt Aaron Kennedy, MS
It's not actually a benefits issue. It's a cost analysis issue. It's "inconvenient" to the Vet/Retiree, however there is sound logic behind it. I've expanded on exactly why they do it on my post. I ran into this issue a few years back for my own meds, since I fall under the VA Prescription plan (as opposed to TriCare), It's essentially a "mirroring" of the systems.
CC: Col Joseph Lenertz
CC: Col Joseph Lenertz
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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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