MOAA Members Share Their TRICARE Pharmacy Challenges

MOAA Members Share Their TRICARE Pharmacy Challenges
Photo by Deidre Smith/Navy

A recent article addressing MOAA’s work to improve TRICARE pharmacy coverage resonated with frustrated members, and many contacted us to share their experiences with the TRICARE pharmacy program. We appreciate member feedback and will use these stories to build support for our pharmacy priorities as the FY 2022 National Defense Authorization Act (NDAA) moves forward.

 

Many MOAA members were surprised to learn nearly 19,000 beneficiaries have been negatively impacted by TRICARE’s non-coverage of Dexilant, a drug treating gastroesophageal reflux disease (GERD) and used in the maintenance of healed erosive esophagitis. Among those who reached out to MOAA were two surviving spouses in their 90s:

 

“I am a military widow, 94 years of age, and was on the medication Dexilant for 11 years with absolutely no problems, before TRICARE eliminated it. I have been on a number of medications to replace Dexilant and none were effective. On June 20, 2021, I was taken to the ER where I was misdiagnosed with a heart attack, because my GERD was not under control since I was not on Dexilant. I appreciate you in trying to get Dexilant reinstated to the Tricare Formulary system as are the other 19,000 patients.”

 

“I read your article and wanted to let you know I am one of the people affected by TRICARE’s decision to eliminate coverage for Dexilant. My doctor has been giving me samples, but at my last appointment she said she was running out. I’m afraid I won’t be able to get more and then my pain will return. I’m 91 years old and just trying to get through without suffering every day.”

 

[RELATED: MOAA’s Surviving Spouse Corner (Updated Monthly)]

 

Servicemembers and their families make extraordinary sacrifices in support of our nation. Their health care benefit should provide comprehensive coverage that is at least on par with commercial plans. Our research shows most commercial plans and other government payers cover Dexilant, so we have been focused on getting the drug reinstated to the TRICARE formulary.

 

TRICARE formulary decisions involve a lengthy multistep review process required by statute. Where does Dexilant stand in that process? In February, the DoD Pharmacy and Therapeutics Committee reevaluated its non-coverage decision for Dexilant. The next step is a review by the Beneficiary Advisory Panel (BAP), but the BAP was suspended earlier this year as part of a zero based review of DoD Advisory Committees. The panel is preparing to reconvene, and we expect a meeting announcement shortly.

 

Many thanks to the MOAA members who have shared their feedback. Your stories help us show Congress the real-world consequences of TRICARE policy decisions. We anticipate doing a Call to Action on this issue later in the NDAA process, so please stay tuned for updates and continue to relay your coverage concerns to us.

 

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About the Author

Karen Ruedisueli
Karen Ruedisueli

Ruedisueli is MOAA’s Director of Government Relations for Health Affairs and also serves as co-chair of The Military Coalition’s (TMC) Health Care Committee. She spent six years with the National Military Family Association, advocating for families of the uniformed services with a focus on health care and military caregivers.