TREA Legislative Update for 4/28/06 - Part 1

[DonaldN]

TREA Legislative Update for April 28, 2006


NOTE: We have added letters for you to send to your Congressional Representatives for most of the bills that we are following on Capital Hill. All of the bills listed under "Action Alert" at http://capwiz.com/trea/home/ have letters attached to them. Click on them, and enter your zip code, and you will find out if your Senator/Representative is a Co-Sponsor or a non-sponsor, and an appropriate letter is available for you to email, or print out and send.

Congress Back in Town-Congress is back in town and the swirl of legislation is back (it never really stopped during the break.) It seems like the strongest message that the members of Congress received from their constituents was about gas prices. On Wednesday alone the Senate held 12 hearings and the House an amazing 41 hearings. The Senate also took up the House’ $106.5 billion Emergency Supplemental (HR 4939 Fiscal 2006 Emergency Supplemental to Iraq/Hurricane Relief) on the floor and the House dealt with lobbying reform and Iran.

The House’s Armed Services Committee’s Subcommittee on Military Personnel and Strategic Forces marked up the DoD budget this week. Chairman McHugh (R-NY) indicated that he wanted both a GAO study as well as a task force stood up to analysis the need for the proposed increases in TRICARE Prime and Standard for retirees under the age of 65. The Committee then rejected the all proposed increases in annual enrollment fees, deductibles and drug co-pays and restored the $735 million to the budget that the Pentagon estimated would be saved by their proposals. This is very good news indeed. The full House Armed Services Committee will take up the mark-up on May 3.

However there are unconfirmed reports flying about this town that some Senators may be willing to agree to a COLA increase of the TRICARE Prime benefits for retirees under the age of 65 for this year’s NDAA while the GAO is conducting a study. It is just an unconfirmed rumor but it means that DOD is still pushing hard to get something this year. So, please, do not let up. Keep calling or writing your members of Congress and tell them of your opposition.

President Riddell Comes to Washington-TREA’s President Riddell was in Washington all this week speaking to key Senators and Congressmen and their staffs concerning the needs of Military retirees and their families. He met with the leaders of both the Armed Services and VA Committees as well as with the Minnesota delegations. On questions concerning the VA he spoke of the need for full funding for VA healthcare, Medicare subvention, proposed improvements in the education benefits and TREA’s opposition to the proposed increases in fees for Categories 7 and 8 enrollees. On the DoD side he made clear TREA’s strong opposition to the proposed increases in enrollment fees and co-pays for TRICARE Prime and Standard for retirees and their families under the age of 65 and our concerns about BRAC implementation.

Disabled Veterans Tax Fairness Act-Senator Blanche Lincoln (D-AK) has just introduced S2503 which is a companion bill to Representative Sam Farr’s (D-CA) HR 4727. Both bills would allow disabled veterans to go back more than 3 years (the present law) and modify their federal tax returns if their VA disability claims take more than 3 years to process. Since the retroactive payments go back to the date of application and any disability payment is tax free (unlike military retired pay) this can mean significant tax savings to the disabled retiree. At the present time S2503 has 6 co-sponsors while HR4727 has 36 co-sponsors. This change would be a real help to some of our Disabled Military Retirees. If this would help you or someone you know please call your members of Congress right away.

TRI-WEST Trip to the Midwest-Last week TREA’s National Legislative Director, Deirdre Parke Holleman, traveled with TriWest, to areas in the West TRICARE region that will be affected by BRAC and realignment. TriWest is the civilian TRICARE contractor for the region. TREA and representatives from 4 other Associations met with the Commanders of the MTF’s at the Air Force Academy and Evans Fort Carson’s Evans Community Hospital at Colorado Springs; Ft. Riley, Kansas and Whitman Air Force Base in Colorado. All the installations are going to see major changes in the next few years. The Air Force Academy Hospital is becoming a clinic while Evans will be taking on some of the care. Fort Riley’s populations is going to grow dramatically based on present realignment plans and Ft. Whiteman is maintaining the B-2 fleet and the special medical needs of crews that fly missions as long as 44 hours at a time. TriWest also held a roundtable with medical beneficiaries (including TREA’s Memorial Foundation Chair Bill DeBoer), Congressional staffers, their employees and the Associations representatives in Colorado Springs to get a local view of what are the medical needs and concerns of the local beneficiaries are. The trip was a terrific way to get a on the ground feel for the effects the legislative changes in Washington are having throughout the country.

[DonaldN]

TREA Legislation Update For 4/28/06 - Con'T.

DoD Announces more changes in the Uniform Formulary-Below please find the latest restructuring of the TRICARE formulary. The latest movement to third tier are drugs in the following categories: Overactive Bladder Agents, Antihypertensive Agents, and GABA Analog Agents. The 6 drugs being moved into the $22 co-pay third tier all go into effect on July 26, 2006.

TRICARE Uniform Formulary Update

April 26, 2006

No. 06-13

FALLS CHURCH, Va. -Dr. William Winkenwerder Jr., director, TRICARE Management Activity, made the decision to place additional medications on the TRICARE Uniform Formulary and to designate others as nonformulary (or third tier) on April 26, 2006. The following chart shows the medications, their status as formulary (tier-one generics or tier-two brand name) or third tier and the date the decision will be implemented.

Items listed in the following sequence.- Don

Medication
Tier
Implementation Date of Nonformulary Status

Overactive Bladder Agents

Detrol®
3
July 26, 2006

Detrol LA®
2
**

Ditropan XL®
2
**

Enablex®
2
**

Oxytrol®
3
July 26, 2006

Oxybutin generic only
1
**

Sanctura®
3
July 26, 2006

Vesicare®
2
**

Miscellaneous Antihypertensive Agents

Catapres TTS®
2
**

Clonidine/chlorthalidone generic only
1
**

Clonidine generic only
1
**

Guanabenz generic only
1
**

Guanadrel generic only
1
**

Guanethidine generic only
1
**

Guanfacine generic only
1
**

Hydralazine generic only
1
**

Hydralazine/HCTZ generic only
1
**

Inversine®
2
**

Lexxel®
3
July 26, 2006

Lotrel®
2
**

Methyldopa generic only
1
**

Metyrosine generic only
1
**

Minizide®
2
**

Minoxidil generic only
1
**

Prazosin generic only
1
**

Reserpine generic only
1
**

Tarka®
3
July 26, 2006

Gamma-aminobutyric acid (GABA)-Analog Agents

Gabapentin generic only
1
**

Gabitril®
2
**

Lyrica®
3
June 28, 2006


** Doesn't apply

THE PROCESS

Public Law 106-65 required the Department of Defense (DoD) to establish a uniform formulary for its prescription benefit. The law further required that nonformulary drugs must be available from at least one venue, with a higher copayment. DoD stated in the Code of Federal Regulations that nonformulary or third-tier medications would be generally available through the TRICARE Retail Pharmacy Network (TRRx), non-network retail pharmacies and the TRICARE Mail Order Pharmacy (TMOP) for higher copayments.

Pharmacy and Therapeutics Committee

The DoD Pharmacy and Therapeutics (P&T) Committee reviews the medications for relative clinical and cost effectiveness in selected therapeutic classes on a quarterly basis. The schedule for therapeutic class reviews may be found at www.pec.ha.osd.mil/PT_Committee.htm.

The P&T Committee evaluates relative clinical effectiveness by examining information about safety, effectiveness and clinical outcome. The Committee considers such information as U.S. FDA-approved and other studied indications, results of safety and efficacy studies, results of effectiveness/clinical outcomes studies and input from relevant providers in the direct care system. The P&T Committee is composed of DoD physicians and pharmacists, as well as professional representatives from the Veterans Administration. After the clinical review, the Committee does a cost-effectiveness review. Based on these two reviews, the P&T Committee makes its recommendations on which medications should be included on the Uniform Formulary (with first-or second-tier copayments) and those medications designated as nonformulary or third tier. The P&T Committee then submits the implementation timelines for these recommendations.

Beneficiary Advisory Panel

Congress established the Uniform Formulary Beneficiary Advisory Panel (BAP) to review and comment on the recommendations of the P&T Committee. Members of the BAP include active duty family members, retirees and retiree family members, two clinical experts outside of DoD, a pharmacist from the Uniformed Services Family Health Plan and physicians or pharmacists from the TRICARE regional contractors and the pharmacy contractor.

The P&T Committee forwards recommendations, along with the comments from the BAP, to the director, TRICARE Management Activity for consideration prior to a final decision.

Beneficiary Input

The Military Health System encourages TRICARE beneficiaries to be part of the process by communicating their concerns to the BAP. Information on such communication may be found in the Federal Register announcement of the BAP meeting, which is posted on the BAP Website at www.tricare.osd.mil/pharmacy/BAP/ two to six weeks before the public BAP meeting along with the agenda outline for the meeting.

Beneficiary Cost Shares

Medications on the first tier (formulary generics) are available through TRRx for $3 for up to a 30-day supply and through TMOP for $3 for up to a 90-day supply. Medications on the second tier (formulary brand name) may be purchased for the same number of days for $9. Medications on the third tier (nonformulary) require a $22 copayment in both venues. Beneficiary copayments are higher at non-network retail pharmacies.

Beneficiaries currently on third-tier medications may wish to consult their health care providers about changing to a first-or second-tier alternative. They may also ask their provider if establishing medical necessity for the third-tier medication is appropriate for them. If medical necessity for a third-tier medication can be established, copayments revert to $9. Third-tier medications will not be available at military treatment facility (MTF) pharmacies unless medical necessity has been established and the prescription is written by an MTF provider. Not all tier-one and tier-two drugs are available at MTF pharmacies. For a list of medications, their formulary status and where they are available, interested parties may go to http://www.tricareformularysearch.or...r/default.aspx. Medical necessity forms and criteria are available at http://www.tricare.osd.mil/pharmacy/...nformulary.cfm.

Additional information on both TRRx and TMOP and the location of the nearest TRICARE retail pharmacy may be accessed at www.express-scripts.com/TRICARE or by calling 866-363-8667 for TMOP or 866-363-8779 for TRRx.

I hope posting this helps a veteran today!