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Capitol Connections Article [Tricare] [06/27/2013]
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TriCare Latest to Deny Compounded Medicines

TriCare, the federal health benefit program for active military and their families, began sending letters to plan participants informing them that effective July 24, 2013 any compounded medicine prepared with APIs would no longer be covered.  These letters, issued by TriCare's contracted pharmacy benefit management company Express Scripts (ESI), claim that the plan does not cover "non-FDA approved drugs." Click here to view letter. This in spite of an internal document which IACP obtained which shows that TriCare and ESI have been reimbursing for compounded medications based on APIs for the past ten years.

"Denying access to necessary medications -- based on the decision of a patient's physician and individual health needs -- is bad enough," said IACP President Wade Siefert upon hearing the news.  "To have that burden be placed upon a man or woman serving our country is shameful.  Congress needs to know how our military and their families are being treated."  

And that's exactly the tact which IACP has taken.  In addition to reaching out to select members of the Washington DC media to educate them about this issue, IACP's lobbying team has already met with both Senators and Congressmen to call attention to this sudden and unprecedented change.  "The response we've had in our meetings has been one of both surprise and determination," said IACP Vice-President of Government Affairs Sarah Dodge.  "That TriCare can make such a drastic change without considering the financial impact on their beneficiaries or what additional costs the federal government will have to pay as patients have hospital and physician visits to unnecessarily change their medicines is troubling.  Especially in these times of tight budgets."

Neither TriCare nor ESI appear to have considered how unbalanced their decision is.  The program continues to reimburse for non-FDA approved manufactured products such as thyroid hormone, codeine, digoxin and the more than 200 medicines that predate the existence of the 1938 Food Drug and Cosmetic Act that established an FDA review process.  More importantly, rather than acting as a benefit management plan, ESI appears to have abandoned that responsibility entirely instead of establishing commonplace processes like prior-approval or step-care.  Instead, it has advised TriCare to simply stop paying for medicines without regard to patient needs.

While IACP will continue to raise this issue at the federal level, every member who provides services to TriCare patients can do their part as well.  Watch for a special IACP Member Alert tomorrow with tools and resources to use in helping your TriCare enrollees reach out and express their own concerns to Congress.

As President Siefert says:  "They've protected us… now we have to protect them."

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