I am at a point in my life where I am not sure how much more I can take. Where if one more ineffectual policy is passed, I might break. I have heard the term “Semper Gumby” in reference to the Marine Corp, and though I am an Air Force wife, I believe this phrase applies to me at this moment. I must be flexible, more flexible than I have ever been. And I must be able to snap back into shape, like Gumby.
Last week I was told about an upcoming TRICARE policy change that is ineffectual and disregards patient care. Military families, service members, veterans, and retirees are going to face yet another cut to their medical care. This time though, TRICARE has made changes to their pharmaceutical policies in regards to compounding pharmacies.
“Starting July 24, TRICARE will no longer cover compounded prescriptions that contain drugs not approved by the Food and Drug Administration,” according to Navy Times.
Appearances are truly deceiving with this policy change. I mean, who wouldn’t want a medication that isn’t FDA approved? After all, look at what happened in Boston with the meningitis outbreak and the bulk processing that was used in those compounding pharmacies. However, not every compounding pharmacy is like the one from Boston.
Patients need compounding pharmacies. These pharmacists tailor-make medications to meet the individual healthcare needs of the patient. Children and adults are allergic to dyes, soy, gluten, lactose just to name a few, and those patients must have compounded medications. Children with special needs such as Autism, or those that require a feeding tube, need specialty, compounded medications.
While this policy that states that FDA approved medications will be approved by TRICARE and Express Scripts, that’s not entirely the case. After speaking with my pharmacist in Fayetteville, NC, I have discovered that nothing – NOTHING – will be covered.
“TRICARE is stating that they are not covering compounded medications because they are made using ‘bulk chemicals not approved by the FDA’. Compounded medications use United States Pharmacopeia (USP) and National Formulary (NF) bulk chemical ingredients. These chemicals are purchased from a licensed FDA vendor who will perform additional analytical testing to ensure it conforms to all national and international standards. These are the same chemicals that are used by drug manufacturers which make FDA approved medications and products.” –Letter from Stewart Compounding Pharmacy
Let’s break that paragraph down and translate what it actually means. The first part provides a summary of the new TRICARE policy – what TRICARE is not going to cover and why. Okay, well that’s good to know. The middle and end are what really get to me. A non-profit, United States Pharmacopeia and the National Formulary use bulk compounding ingredients which are actually bought and paid for by a licensed FDA vendor. The people who make up our list of medications buy ingredients from an actual FDA-approved vendor. Also, USP is willing to go over these chemicals and ingredients just to ensure that FDA standards are met.
Again it appears that this shouldn’t be an issue and that compounded medications that are not FDA-approved will not be covered, right? Wrong. It’s taken me a few days of research, but I have finally found out why no medications will be covered despite the “FDA approval” disclaimer from TRICARE.
When medications are compounded to meet the individual needs of the patient, the FDA approved formula of that medication is altered. It’s that altering of the original formula that is not approved.
That is why no compounded medications will be approved by TRICARE. The moment the FDA approved formula is changed to the meet the need of the patient; the changed formula of medication is no longer considered FDA-approved. It could be the same medication just changing from solid to liquid form!!!! Do you know how asinine that is???
Thank you TRICARE for another policy change that is not at all user friendly. You, TRICARE, have given your beneficiaries a policy that will only negatively affect patient care at all levels.
I am so MAD! I’m mad and frustrated. I feel like I’m banging my head on a wall trying to explain to people why this is a HORRID policy change. People really don’t understand why this is a problem and why families are getting tired of fighting. I’m exhausted and never in my life have I felt this defeated.
I have spent almost two years advocating on behalf of military families to our elected officials. For almost two years, they have all agreed that TRICARE policy is helpful to one entity only and that’s TRICARE; yet we see little positive change. For every step forward, it’s at least two steps back.
How can families that are already pushed to the limits get back up and fight again and again? We are pushed to limits with multiple deployments, loss of spousal employment, lackluster pay, cuts in benefits, and broken promises.
My husband pays for our insurance with his life. We pay for our insurance with the lives of men and women who volunteer to be a part of something bigger than them. This is how we are thanked . . . with cutbacks and lies.
And while I feel defeated now, I know I will get up again and fight another day. I can’t fight this alone, and I shouldn’t have to. If TRICARE is willing to install policies like this one, then other insurance companies could, too. Almost 75% of children’s medications are compounded. That’s all children in America, not just military children.
This country can no longer afford to take advantage of the most underprivileged, overworked group of people.
We military should not have to fight for our rights and benefits at home while we fight for the protection and freedom of our nation on the frontline. The time has come for our elected officials to say enough is enough to TRICARE.
It’s time to stand up for what is right. Join me!!!
Click on this link so you can contact your elected official.