Mandatory ‘mail order’ begins for TRICARE elderly

March 20, 2014        

By Tom Philpott

About 500,000 military beneficiaries age 65 and older with chronic health conditions are being forced, starting this month, to have maintenance drug prescriptions filled by mail order rather than in local retail pharmacies.

The TRICARE For Life (TFL) Home Delivery pilot is a yearlong program required by law. Defense Department health officials project it will save the government $120 million per year in retail drug costs and save beneficiaries $28 million a year in lower drug co-payments.

By the time the pilot program ends, officials project that 95 percent of beneficiaries forced to use home delivery will be so satisfied with the convenience and savings they will stay with mail order voluntarily rather than return to neighborhood druggists for the kinds of medicines they will have to take for the rest of their lives.

“We are making it easier to stay,” said Rear Adm. Thomas J. McGinnis, chief of pharmaceutical operations for the Defense Health Agency.

“We have auto-refills of medications where beneficiaries can check a box and, every 80 days or so, get either a phone call or an email -- whatever they signed up to receive -- notifying them that their medication is going to ship next week. They only have to call a number if they don’t want that medication.  So they automatically get it every 90 days. They don’t have to think about it so they don’t run out of medication.”

Another feature of TFL Home Delivery is auto-renewal of prescriptions.

“Prescriptions are only good for one year, in every state, and then beneficiaries have to go get a new prescription,” McGinnis said. With mail order, however, the contractor, Express Scripts Inc., will query a beneficiary’s physician to ask if this time they will renew the prescription automatically or if they want to see the patient first.

“Eighty percent of the time they will renew the prescription without having the beneficiary come in…So that’s going to help, again, keep our beneficiaries out of retail. That’s why we say, ‘You only have to try this for one year and that’s it.’ You try it, you’ll like it,” McGinnis said.

Many TFL beneficiaries have known about the pilot for months, from news reports on the mandate Congress enacted more than a year ago.  So thousands of TLF beneficiaries who take medicine routinely to control high blood pressure, diabetes, cholesterol and other chronic conditions have been shifting their maintenance meds to mail order steadily over the past year.

Last month, however, every TLF beneficiary identified as having used retail pharmacies in recent years for maintenance drug refills – a total of 350,000 households -- received a letter from TRICARE explaining that those prescriptions must be switched to mail order by March 15.

Elderly beneficiaries who continue to use retail druggists for these types of medicines after that date will get a second letter warning them again that they must convert to mail order within 30 days.

“There will also be outbound phone calls reminding them to just call this number and we will help them transfer medication to mail,” McGinnis said.

If they continue to use local drug stores for these prescriptions, a third letter will be a final notice before TFL beneficiaries will be forced, after May, to pay 100 percent of the cost of maintenance drug dispensed at retail.

That’s the hammer for TLF beneficiaries who refuse to shift. The hook is that their co-payments will fall, saving TFL beneficiaries as a group a total of $2.3 million monthly, McGinnis said.

“It’s a no brainer, especially for the over-65 population. Those folks average four or five medications. Even if they have just one generic and one brand name medication [home delivered], that will save them $212 a year.”

Beneficiaries on four to six maintenance medications could save more than $600 a year “for the same drugs and more convenience, and you don’t have to remember to pick it up every month at the retail pharmacy,” he said.

Beneficiaries typically pay $60 a year in co-pays for generic drugs at retail. Generic drugs are free through home delivery.

Another bit of good news is that the process to shift to mail order couldn’t be easier, McGinnis explained. All of the warning letters will contain the same phone number: 1 877-882-3335  

“We tell them, ‘Just call this number.  It’s a concierge service. They will walk you through the registration process if you have never used mail before,’ ” McGinnis said.  Express Scripts staff will “get all the information from the beneficiary so it very easy to register and use mail order. They will even offer to call their doctor to transfer that prescription to the mail order pharmacy.  So it’s truly a concierge-type service to help beneficiaries move.”

Not impacted by the mail order mandate are elderly beneficiaries who have prescriptions filled in base pharmacies where the cost of drugs to the government also is far less than at retail pharmacies. TFL beneficiaries needing drugs for acute conditions or having maintenance drug prescriptions filled for the first time also can use retail outlets.

TRICARE will allow waivers from mandatory mail order in special circumstances, to include TFL beneficiaries in assisted-living facilities or nursing homes where mail order might not be practical.   

For several years, TRICARE pharmacy officials have led an information campaign to encourage beneficiaries on maintenance drugs to use mail order because of the substantial savings. By 2011, about one million military prescriptions a year were being filled through mail order. By the start of 2014, that annual average was 1.77 million, an increase of 77 percent.

Over the next year, because of the TFL Home Delivery pilot program, McGinnis said, mail order prescriptions should double to 3.3 million. That’s out of a total of 140 million military prescriptions filled annually across all three venues of base pharmacies, retail outlets and home delivery.

Having led the TRICARE pharmacy directorate as its first chief for the past eight-and-a-half years, and more than 36 years as a Public Health Service officer and pharmacist, McGinnis will retire May 1.

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