MOAA Wants Your Pharmacy Feedback

 Recently, MOAA joined a gathering of senior leaders at the Defense Health Agency (DHA) to discuss improvements for the TRICARE health plan.

     Express Scripts is the TRICARE program’s pharmacy benefit manager, and representatives were on hand to present a review of their beneficiary engagement activities. The TRICARE pharmacy benefit remains one of MOAA’s key focal areas, and our membership counts on us to interact with both TRICARE and Express Scripts to provide insight and feedback from the beneficiary perspective. 

     TRICARE’s pharmacy program plays a big part in the operations of the military health care system. For instance, on a weekly basis 2.45 million prescriptions are filled. Over 1 million of these are filled in the TRICARE pharmacy network, and Express Scripts fills close to a half a million prescriptions through the Home Delivery program. 

     Pharmacies located within military hospitals round out this massive volume by dispensing over 800,000 additional prescriptions each week.

     Needless to say, this dispensing activity represents an enormous amount of beneficiary engagement in their health care. 

     Express Scripts also plays a significant role in helping move more beneficiaries into the Home Delivery program. To this end, they recognize that meeting and communicating with the beneficiary where they are most receptive and comfortable is instrumental to achieving a positive experience. 

     Express Scripts has focused on the experience of care and invested in improvements such as chat capabilities, improving order turn-around times, enhanced auto refills, digital benefits information, virtual consultations with pharmacists and physicians, social media support, and much more. 

     One particularly helpful tool is the Find a Pharmacy feature found on the Express Scripts website and through their mobile app. Beneficiaries can locate the closest in-network pharmacies, find pharmacies that are open 24-hours, etc. 

     “We’re pleased that Express Scripts values insights from our MOAA members, and we hope to continue to provide it so we may be a part of the development of meaningful technology and other improvements” said MOAA President and CEO Lt. Gen. Dana Atkins, USAF (Ret). 

If you have comments, concerns, or compliments about your experience with Express Scripts Inc. or the TRICARE pharmacy program generally, we want to hear from you. The feedback you provide may help shape the future of these benefits. Send your thoughts to beninfo@moaa.org

STEPS TO SUBSCRIBE TO MOAA’S WEEKLY LEGISLATIVE UPDATE AND CONTACT YOUR LEGISLATORS ONLINE

  1. Subscribe to MOAA’s free weekly legislative update:
  1. Click “Login” at www.moaa.org   First time login?  Have MOAA member # and your email address handy and click “Create Web Login” & follow prompts.
  2. When logged in click Account then “My Subscriptions & Notifications”.
  3. On next screen, enter your email address and click “Search”.
  4. Your profile page will come up. Check the MOAA Legislative Update box (and any other email newsletters you’d like to receive).  Click on “Home” in upper right corner to return to home page.
  1. Take action anytime or when prompted by MOAA’s weekly update:
  1. At the MOAA home page (www.moaa.org), click “Take Action”.

  and select “Legislative Action Center” in the drop down menu.

  1. Under featured alert, click “Take Action”.
  2. Confirm or correct your zip code and click “Go”
  3. Review/edit the suggested email and complete your sender info at bottom
  4. Important: if using your own computer, check the box that says “Remember Me” at bottom of form, then click “Send Message”
  1. Find where your legislators stand on MOAA supported bills and send them an email about those they have not yet co-sponsored:
  1. At the MOAA home page (www.moaa.org), click “Take Action”.
  2. Click on “Legislative Action Center” then “Elected Officials”. Enter your zip code and click “Go”
  3. Click on “Bills” under any of your legislators
  4. Click on “Send Message”. Review or edit the suggested message, verify your contact info is correct, and click “Send”.
  5. Repeat these steps for each bill your legislator hasn’t co-sponsored.
  6. Repeat for each of your legislators.
  1. No computer?  Call MOAA member services (800) 234-6622 and listen to the current legislative update, then call your congressmen.

 Thanks for adding to MOAA’s ONE POWERFUL VOICE!

AVALANCHE OF ENACTED TRICARE CHANGES POSES CHALLENGES

The National Defense Authorization Act (P.L. 114-328), signed into law Dec. 23, orders an avalanche of changes to the TRICARE health care benefit used by servicemembers, retirees, and their families. It also makes sweeping reforms to how the military direct-care system is organized and operates. The provisions to modernize TRICARE and improve access will only accelerate reforms that the department already has been piloting or planning to adopt, though perhaps not at the speed Congress desired. The department’s guide has been recommendations of the 2014 Military Healthcare System Review, which then-Defense Secretary Chuck Hagel ordered to take a hard look at performance and outcomes at military facilities and through civilian purchased care networks.  Beneficiaries have started to see the fruits of that effort in greater access to care and a nurse advice line. They will see more when the new generation of TRICARE purchased care contracts takes effect this year, and also with gradual rollout of MHS Genesis, the new electronic health records system. All this before many of the new defense bill initiatives kick in in 2018 and years beyond.

Congress staggered deadlines in the law across a span of years.  There are gems in the law for families seeking more timely care.

One provision ends a requirement that TRICARE Prime users get referrals from primary care providers before using a neighborhood urgent care facility. Another provision mandates that military treatment facilities with urgent care clinics keep them open daily until at least 11 p.m.  Those “are both wins for families,” said Brooke Goldberg, deputy director of government relations for family issues at Military Officers Association of America. Other law highlights she noted require:

Adoption of a standardized appointment scheduling system across all of military health care and also first-call resolution of appointments. New TRICARE contracts incentives to improve beneficiary access, care outcomes, and enhanced beneficiary experiences.

Adoption of new productivity standards for care providers in military treatment facilities, which should mean more on-base appointments. Military providers’ performance reports to include measures of accountability for patient access, quality of care, outcomes, and safety.

Military families will be eligible by 2018 to buy vision coverage through federal employee health programs, explained Karen Ruediseuli, government relations deputy director for National Military Family Association. Retirees and dependents will be eligible for both dental and vision programs.

Some changes touted by Congress are not quite what they seem. For example, the planned narrowing of three insurance options – TRICARE Prime, Standard, and Extra – down to two, with Prime still providing managed care and TRICARE “Select” offering a preferred provider network, is largely a name change push by DoD. Goldberg said it could even be “transparent to families who really don’t know the nuances of Standard vs. Extra.”

Still to be determined “is what the preferred-provider network will look like and will families be able to easily discern which services will result in higher costs? And will they have access to providers who are low-cost?” For example, current TRICARE provider networks include those who participate in Prime and agree to take a discount from the normal Medicare-based payment. But many providers willing to see Standard patients for its allowable fee will not see Prime patients with its lower fee. “Will those providers be considered preferred providers under TRICARE Select, or will the Select network only include those who participate as part of the Prime network? If the former is true, then the transition likely will be smooth. If the latter is true, many more people could be hit with out-of-network charges, to the extent they aren’t grandfathered,” said Goldberg.

Adding some confusion is language that grandfathers current generations of military families and retirees from a new schedule of higher fees to hit those who enter service on or after Jan. 1, 2018. But the law will require current beneficiaries to enroll in Select, as they do with Prime, and enrollment will carry a fee for retirees under age 65, beginning in 2020, if a government audit confirms improvements in quality care and patient access.

Guice took exception to one senator’s characterization of the new law as a “first step in the evolution” of military health care from “an under-performing, disjointed health system into a high-performing, integrated” one.

She noted a recent National Academy of Medicine study on military trauma care that found that over a decade of war the U.S. military had made unprecedented gains in survivability rates from battlefield wounds.

“I don’t think that’s reflective of an underperforming system at all,” Guice said. “The people who created that learning system of care are the same people who provide the in-garrison care. That is evidence we really do value constant performance improvement.”

2017 PART B PREMIUMS ANNOUNCED

Medicare finally announced the 2017 Part B premiums. 70 percent of Medicare beneficiaries won’t see much of a Medicare Part B premium increase next year. If you’re paying $104.90 a month in 2016, you’ll likely pay around $109 monthly next year. If you’re paying more than that now, you’ll probably see about another 10-percent hike for 2017. The majority of beneficiaries won’t see a large fee hike because of a “hold-harmless” law that caps most people’s Part B premium increase at the dollar amount of the Social Security check cost-of-living adjustment (COLA).

But that protection doesn’t apply for the following groups:

  1. New Medicare enrollees in 2017 (who aren’t “held harmless” because they never paid the lower premium);
  2. Medicare enrollees with incomes above $85,000 a year ($170,000 for a married couple), who already pay premiums higher than the basic $104.90; and

3.People who are paying Medicare premiums but don’t receive a Social Security check.

Not only are these groups not “held harmless,” but the law actually requires their premiums to be raised an extra amount to cover whatever total premium amount the held-harmless groups would have been paying if they hadn’t been protected. In other words, when a small or zero COLA triggers the hold-harmless provision, the three groups listed above end up having to pay their own premium hikes…and part of their neighbors’, too. Last year, the zero-COLA meant a 52-percent increase for beneficiaries not held harmless. MOAA members sent over 24,000 messages to the Hill, and Congress intervened to protect these groups from having to pay any share of other people’s premiums.

This year, because there was at least a .3 percent COLA, the penalty for the non-held-harmless groups isn’t quite as severe. Further, Medicare officials already announced they will use Medicare reserves to partially ease the extra premiums imposed on these groups. The chart below shows the 2017 monthly premium rates just announced by Medicare. Premiums for individuals with incomes less than $85K/$170K (single/married) may vary a dollar or two, because your individual premium will be based on the size of the COLA in your personal Social Security chec

Because Medicare is using its reserves to ease increases on those not held-harmless, some think there won’t be as much pressure on Congress to step in with more relief.

As a matter of principle, MOAA thinks it’s wrong to make the groups already being asked to pay a larger share of their own Part B premiums to shoulder a share of someone else’s, too.

That’s why MOAA will be supporting relief legislation again this year. If successful, we estimate that would save the affected groups $8 to $15 per month ($16 to $30 for a married couple).

STEPS TO SUBSCRIBE TO MOAA’S WEEKLY LEGISLATIVE UPDATE AND CONTACT YOUR LEGISLATORS ONLINE

  1. Subscribe to MOAA’s free weekly legislative update:

  1. Click “Login” at www.moaa.org   First time login?  Have MOAA member # and your email address handy and click “Create Web Login” & follow prompts.
  2. When logged in click Account then “My Subscriptions & Notifications”.
  3. On next screen, enter your email address and click “Search”.
  4. Your profile page will come up. Check the MOAA Legislative Update box (and any other email newsletters you’d like to receive).  Click on “Home” in upper right corner to return to home page.

  1. Take action anytime or when prompted by MOAA’s weekly update:

  1. At the MOAA home page (www.moaa.org), click “Take Action”.

and select “Legislative Action Center” in the drop down menu.

  1. Under featured alert, click “Take Action”.
  2. Confirm or correct your zip code and click “Go”
  3. Review/edit the suggested email and complete your sender info at bottom
  4. Important: if using your own computer, check the box that says “Remember Me” at bottom of form, then click “Send Message”

  1. Find where your legislators stand on MOAA supported bills and send them an email about those they have not yet co-sponsored:

  1. At the MOAA home page (www.moaa.org), click “Take Action”.
  2. Click on “Legislative Action Center” then “Elected Officials”. Enter your zip code and click “Go”
  3. Click on “Bills” under any of your legislators
  4. Click on “Send Message”. Review or edit the suggested message, verify your contact info is correct, and click “Send”.
  5. Repeat these steps for each bill your legislator hasn’t co-sponsored.
  6. Repeat for each of your legislators.

  1. No computer?  Call MOAA member services (800) 234-6622 and listen to the current legislative update, then call your congressmen.

Thanks for adding to MOAA’s ONE POWERFUL VOICE!