TRICARE For Life (TFL) Pharmacy Pilot
Our pharmacists have put this info together so
that TFL beneficiaries
can have a full picture of this unfortunate program that is being
many of our customers. Some TFL
will be notified they have ZERO choice where to fill some medications
March 14, 2014. THERE IS A
WAIVER AVAILABLE TO THIS PROGRAM, PLEASE SEE BELOW FOR MORE
First of all, we stand firmly on the side of
beneficiaries and subscribers of every other insurance plan, to be able
CHOOSE the pharmacy they use based on service, convenience, and
relationships with pharmacists and other team members.
Independently owned retail pharmacies have
for years now faced an unfair marketplace in which Pharmacy Benefit
(PBMs) can set a tilted copay and contract structure that coerces
use their company owned mail order pharmacies.
That is what is happening in the case of TRICARE.
Express Scripts is the PBM that administers the
TRICARE pharmacy benefit, and they have tilted copay structures that
beneficiaries to use their own Express Scripts Mail Order Home Delivery
service. We have nothing against Express
Scripts or any other PBM competing for business IF it is done on an
playing field. Having PBMs administer
programs with taxpayer funds where the rules are set up differently for
for them AND in their favor by way of different copay amounts is
anti-competitive. Again, some may find
mail more convenient and in America that should be that customer’s
choice. However, coerced mail order, taken
to a whole
new level with this MANDATORY TFL pilot program, is clearly against the
Trade Commission’s declared strategic goals as posted on FTC.gov (our
Protect Consumers: Prevent fraud, deception, and unfair business practices in the
Maintain Competition: Prevent anticompetitive
in the marketplace.
These coerced mail order programs are often sold
under the guise of cost savings. Who
wouldn’t be for that? Predictably, the
official TFL Pilot program material from Express Scripts repeats this
Retail pharmacies are the most expensive option for
beneficiaries and the
Defense (DoD). Military
pharmacies and the home
option provide savings to
both beneficiaries and
supporting the DoD’s
efforts to control
The evidence which shows that these coerced mail
programs do NOT save the government money is pouring in by way of CMS
studies of the Medicare Part D program.
Order Prices in Part D Often Higher Than Retail, CMS
Mail order pharmacies frequently charge Medicare prescription drug
much as 83%
community pharmacies do for filling prescriptions, a new analysis by the Centers for Medicare &
Services has concluded.
analysis has shown that
negotiated pricing for the top 25 brands and 25 generics combined at
pharmacies is higher than at retail pharmacies for selected PDPs," CMS
said. "Thus, our hypothesis that mail order negotiated prices are lower
than retail pharmacy negotiated prices was not confirmed. Instead, we
prices at mail order
than at retail pharmacies for some PDPs. CMS continues to be concerned
the impact of these prices on the Part D program."
CMS analysis comes on the heels of an earlier 2013 study by the agency finding that
filled at "preferred pharmacies" sometimes result in higher costs to
Medicare than prescriptions filled at non-preferred pharmacies, such as
independent community pharmacies left out of the preferred network.
this year an independent analysis of millions of 2010 Medicare
prescription drug event records found that community pharmacies provide
medication supplies at lower cost than mail order pharmacies and that
pharmacists substitute lower-cost generic drugs more often when
mail order pharmacies.
These analyses don’t even include the massive
occurs with 90 day mail order autoship
pictorial documentation. This doesn’t
happen at the pharmacy counter because of patient to pharmacist
face to face.
For us, it always comes back to the customer in
our work every
day. It turns out nearly 1,200 seniors
have complained to Medicare this year about a litany of problems with
order pharmacies, including shipping unneeded medication and going
medication due to delayed shipments, according to documentation recently released by the Centers for Medicare
So, if it doesn’t save the government any money,
massive waste, and is not liked by Medicare beneficiaries…why are we
out a mandatory mail program to TFL beneficiaries?
Why are coerced mail programs allowed to
begin with? Why not have PBM owned mail
order pharmacies compete for business on an even playing field with
mortar (and pestle J)
(sorry a little pharmacist humor) community pharmacies?
We would really like to know.
What can you do?
The TFL Pilot program is supposed to only involve
name/non-generic drugs. The list of
affected drugs is available
here. The first option is to visit with your doctor and/or pharmacist to inquire about a generic alternative to any medications on this list that you may be taking.
There is also a
waiver to get relief from this TFL Pilot Program:
for a Waiver
In some scenarios, you may
qualify for a waiver from
participating in the Pilot:
Special circumstances, such as
living in a
You Get a
You can continue to fill your
network pharmacies without penalty.
Waivers are granted on a
You or your caregiver can call
To protect your privacy, a person
your behalf must provide the sponsor’s ID number, your name, date of
address, and telephone number.
For those on our Medicine-On-Time
packaging service or our customers in long term care facilities, this
best way to continue using this free value added service we take pride
delivering to our community. Of course
they cite personal needs as well, so any reason you can provide to
doing business here is more convenient should be accepted.
Whether it is because of a pharmacist
relationship, convenience, or anything else we would hope it would be
The other important action is to engage our
legislators. We have been in touch very
recently at the Senate and House level with Patty Murray and Rick
offices. They are aware of the issue and
have advised that the more feedback we can provide the better. ESPECIALLY, if you are denied a waiver. We would like to help facilitate these
communications about your objections to this program via the following
Our twitter feed www.twitter.com/islanddrug
USE THE HASHTAG #tflisldrg
(as in TFL Island
can collect all the posts
Email your feedback to email@example.com
(as in TFL Island Drug)
Mail or drop of any hand or type
to any of our pharmacists.
In summary, we are proud to service those who have
our country and are equally as proud to be part of this military
NASWI. It is staggering to witness that
those who bravely served to protect our freedom now are losing the
walk into a community pharmacy to get a prescription filled. All we are advocating for is that all
customers have an honest choice as to where they fill prescriptions. With your help, we can work together to fight
coerced mail order programs.
Thank you for reading.