February 22, 2008
| COLA Watch.The Consumer Price Index for the month of January jumped 0.5% over December's value. |
| More $22 Drugs. DoD has approved moving eight more medications to the $22 copay level, and restricted access to three others. |
| Tell Us What You Really Think. More than 3,000 MOAA members answered a December survey about their feelings on the condition of the U.S. military. The results may surprise you. |
| Preventive Care? Let's Get Serious. When so much of the rising cost of health care is attributable to care for chronic, preventable conditions, why isn't TRICARE implementing more positive incentives for beneficiaries to use medications and get treatments that have been demonstrated to dramatically reduce long-term health expenditures? |
| DoD Announces New Autism Program. Starting March 15, TRICARE will authorize a new program aimed at expanding availability of expensive treatment for military children diagnosed with autism. |
COLA Watch
The Consumer Price Index for the month of January jumped 0.5% over December's value. That puts cumulative inflation at 1.5% for the first four months of the fiscal year. If inflation kept that cumulative pace for the rest of the year, the 2009 COLA would be 4.5%. But history says that probably won't happen.
Visit our COLA watch page for more information.
More $22 Drugs
On February 13, the Defense Department approved shifting several medications for cardiovascular disorders, enlarged prostate, and immune diseases to the third tier, or $22 copay level.
Chronic heart failure drugs Zebeta, Coreg, Toprol XL, and Lopressor will remain on the formulary at $3 or $9 copays.
Exforge, a combination drug for high blood pressure, will move to the third tier, effective April 16. The copay for Norvasc will move in the other direction, dropping from $22 to $9.
In addition, a new "prior authorization" requirement on prostate drugs will require beneficiaries to try Uroxatral before Hytrin, Cardura, or Flomax, effective April 16, unless they have had a prescription issued for one of the latter three medications within the last 180 days. This means those three medications will carry a $22 copay unless TRICARE approves the doctor's request that there is a "medical necessity" to take one of them. MOAA and other beneficiary representatives have asked DoD to consider moving Flomax back to a $9 copay.
The drugs Enbrel and Kineret, used to treat various forms of arthritis, psoriasis, Crohn's disease, and ulcerative colitis, will move to the third tier effective June 18th. Humira, Raptiva and Amevive remain available for the regular copays.
The contraceptive Lybrel, and ADHD medication Vyvnase will move to the third tier effective April 16.
Tell Us What You Really Think
An article in the March/April issue of Foreign Policy magazine features findings from a December 2007 survey of more than 3,000 MOAA members conducted by MOAA and the Center for a New American Security. Results also included inputs from several hundred active duty officers from other sources.
The purpose of the survey was to get active duty and retired officers' first-hand perspectives on the relative health of today's military.
Selected results from the survey:
- 66% believe America's elected leaders are either "somewhat uninformed" or "very uninformed" about the U.S. military
- 74% think civilian leadership set unreasonable goals for the military to accomplish in postwar Iraq
- Nearly 90% say the war in Iraq has "stretched the U.S. military dangerously thin", but 56% disagree that the demands of the war have "broken the military"
- 78% support expanding options for legal, foreign permanent residents of the United States to serve in exchange for U.S. citizenship
- 53% agree and 44% disagree with the statement "Torture is never acceptable."
- 77% believe the level of U.S. defense spending should be increased over the next 5 to 10 years
- 64% believe that the morale of the U.S. military is "somewhat high" or "very high"
- Only 21% see foreign nation reconstruction operations as a core mission of the U.S. military
Preventive Care? Let's Get Serious
Medical professionals and health system studies consistently report that a large share of the exploding growth in medical costs goes for treatment of chronic or advanced conditions - diabetes, respiratory diseases, heart attacks, cancer, etcetera.
Invariably, the main prescription for action involves extra emphasis on preventive care and early detection.
What does that mean? Strict adherence to medication and regular treatment regimens for people with chronic diseases dramatically reduces their longer-term health costs. Blood pressure and cholesterol medications dramatically reduce the risk of heart attack. Stopping smoking reduces the incidence of lung cancer, emphysema, heart attacks, and a host of other life-threatening diseases.
If you knew all these things, and it was your money TRICARE was spending in treating these conditions, what kinds of changes would you be looking for in military health programs?
Here's a hint: a recent study found that introduction of a $10 copayment requirement significantly reduced the number of women seeking annual mammograms.
MOAA believes it's time to get serious about preventive care. For too long, the response of administration officials to rising health costs has been to stick military beneficiaries with a larger share of the bill, as if the increasing costs were their fault.
But TRICARE simply isn't built to promote healthy lifestyles. At a time when private-sector studies have shown the way to promote adherence to medication guidelines is to reduce copayments for drugs that treat chronic conditions like diabetes, the administration plan is to double or even quintuple pharmacy copayments.
Doctors say the No. 1 thing a smoker can do to reduce his or her long-term health problems is stop smoking. But TRICARE doesn't even authorize coverage for smoking cessation products and services.
The medical world encourages shingles and other vaccinations, colonoscopies, mammograms, and more for prevention and early identification of serious medical conditions, but TRICARE charges beneficiaries a copayment for those services and maybe even sticks them with the whole cost if they haven't yet met their annual deductible.
If they're really serious about reducing long-term TRICARE costs, one of the first things the Pentagon and Congress need to do is stop charging beneficiaries for seeking preventive care that serves exactly that purpose.
And if that's not done, they should think twice before claiming that rising costs are such a big concern to them.
DoD Announces New Autism Program
Active duty military parents of autistic children got good news this week when Assistant Secretary of Defense for Health Affairs Dr. S. Ward Casscells announced that a new TRICARE demonstration program to help autistic children will begin no later than March 15.
The announcement of the new program at an autism conference at Camp Pendleton, CA hosted by Marine Corps Installations West (MCIW) and Naval Hospital Camp Pendleton, and drew applause from attending parents of children with autism.
The new program will recognize a special class of tutors as TRICARE providers to implement applied behavior analysis (ABA) treatment. Finding an ABA-trained provider has been a challenge for many military parents, since their numbers are limited.
"Obviously, it's always about the kids," said Maj Gen Michael Lehnert, MCIW commanding general. "But it's also a good business decision to intervene early…[to help] these children become productive citizens as opposed to institutionalizing them."
Joy Dunlap, MOAA Deputy Director for Military Family Issues, represented MOAA at the conference. "This is a very important improvement for the affected families," she said, "and Dr. Casscells and his staff deserve credit for its rapid implementation. But there's still a great deal that needs to be done to ease financial and administrative challenges imposed on military families affected by autism and other disabling children's diseases."
While the demonstration would create more access to ABA therapy for autistic military children, parents will still have to contend with TRICARE's $2,500 monthly cap on expenses. That limit often doesn't cover the full amount of doctor-prescribed ABA therapy. That means in order to obtain the prescribed amount, many parents will still have to pay thousands of dollars out of pocket each month. MOAA believes raising the $2,500 monthly cap on reimbursement should be a priority.
*After this issue went to press, DoD healthcare officials responded to parents of autistic children and MOAA to revise the newly-debuted autism demonstration program to make it more provider and family-friendly. The program’s goal is to increase accessibility to care for military children with autism.
Revisions announced the week of March 21 include increased payment amounts and added locality rates for those who supervise the newly-designated, tutor-class therapists. Military parents had argued that providers would not sign on to the program with the low initial rates and cumbersome report requirements.
Changes also removed the controversial IQ score of 35 as an eligibility requirement, and allowed for two extra 120-day time periods for development of an Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP) beyond the original 120-day span.
Legislative Update Archives
Keep up to date on legislative action that affects you and your world. Subscribe to our weekly legislative update.
