BRAC could mean higher medical costs

By Tom Philpott

More than 128,000 military beneficiaries taking Viagra or Cialis for erectile dysfunction likely will have to switch this fall to Levitra or face higher co-payments on their prescriptions.
The Defense Department’s Pharmacy and Therapeutics Committee will recommend in mid-July that Dr. William Winkenwerder Jr., the Pentagon’s top health official, narrow the field of impotency drugs dispensed for free at base pharmacies or for a $9 co-payment through the military’s retail pharmacy network or mail-order program.
After a detailed review, the P&T committee concluded that none of popular impotency drugs is more clinically effective but Levitra is cheaper to stock.  Only 10 percent of military patients with erectile dysfunction use Levitra.  Seventy-seven percent use Viagra and 13 percent Cialis.
To save taxpayers $13 million a year, the committee proposes that Viagra and Cialis be moved to “non-formulary’’ status. If Winkenwerder agrees, these drugs no longer will be available on base unless a doctor claims medical necessity. Patients still could get Viagra or Cialis through the TRICARE retail network or by mail order but for a higher $22 co-payment.
On June 27, four of eight members of a beneficiary advisory panel that reviews P&T recommendations advised Winkenwerder to accept this one.  Assuming he will, the panel also advised that the change take effect in 120 days, rather than 90, given the number of patients expected to switch.
INPATIENT SHIFT: Military health officials concede that some retirees will see higher costs if the Base Realignment and Closure Commission accepts a plan to downsize nine stateside hospitals to outpatient clinics and to refer patients needing hospitalization to civilian facilities.
Most of these patients, however, still will be treated by military physicians under facility-sharing arrangements with local communities, said Lt. Gen. George Peach Taylor, Jr., the Air Force surgeon general.
Taylor chaired the Medical Joint Cross-Service Group that shaped the draft BRAC recommendations on healthcare. The hospital downsizing plan, if accepted by the Commission, will impact 148 inpatients a day, 6 percent of all inpatients treated in military stateside hospitals.
Even if patients are treated off base by military physicians, their out-of-pockets costs will rise because TRICARE fees and co-payments for off-base care will apply. Some lawmakers and military associations have criticized the move as an attempt by the Bush administration to deny on-base medical care to more service beneficiaries, particularly retirees and their families.
Taylor, however, said the actual goals are to create a more cost-efficient medical system, improve patient care and enhance medical staff skills and combat readiness.
Hospitals slated to downsize to clinics or outpatient surgery centers are at: the Air Force Academy, Colo.; MacDill AFB, Fla.; Great Lakes Naval Training Center, Ill.; Scott Air Force Base, Ill., Andrews Air Force Base, Md.; Keesler AFB, Miss.; Marine Corps Air Station Cherry Point, N.C., Fort Knox, Ky., and Fort Eustis, Va. The estimated cost-savings is $62 million a year.
Two medical centers also will lose their inpatient mission but to nearby military facilities. Wilford Hall Medical Center at Lackland AFB, Texas, will send inpatients to Brooke Army Medical Center, 16 miles away. Brooke will be renamed the San Antonio Regional Medical Center. Walter Reed Army Medical Center in Washington D.C. will close. Its patients will be treated at Bethesda Naval Medical Center, six miles away, which will be renamed the Walter Reed National Military Medical Center at Bethesda.
Richard M. Dean, executive director of the Air Force Sergeants Association wrote to Commission Chairman Anthony Principi this month, urging careful scrutiny of the rationale behind hospital downsizing. Several hospitals are “heavily used,’’ he said, casting doubt on claims of excess capacity. Retirees and their families, Dean said, “feel they are specifically being targeted’’ and that BRAC 2005 is “a veiled way to push retirees, family members and survivors out of the military health care system in order to avoid funding for their health care and medicines.’’
Rep. Gene Taylor, D-Miss., whose district includes Keesler, said he is worried about higher out-of-pocket costs for young military families.
Whether treated in military or civilian hospitals, active duty family members enrolled in TRICARE Prime, the managed care network, pay no hospital charges. If not enrolled, they pay $13.90 a day at a civilian hospital.
Enrolled retirees and their dependents under age 65 pay $11 day. But under-65 retirees who rely on TRICARE Standard, the military’s fee-for-service plan, pay $250 a day in civilian hospitals, or 25 percent of negotiated charges plus 20 percent of negotiated professional fees, whichever is less.
Older retirees sent to civilian hospitals typically have Medicare and TRICARE for Life coverage, which covers almost all their costs.

Tom Philpott can be contacted at Military Update, P.O. Box 231111, Centreville, Va. 20120-1111, or by e-mail at:
milupdate@aol.com