Congress Speaks: Tricare’s Sweeping Action Hurts Veterans | Commentary

Posted September 14, 2015 at 5:34pm

The House of Representatives took a stand against Tricare to protect veterans’ medical interests and ensure they have access to necessary medications.

Specialty medications are critical for patients who do not respond to treatment through traditionally manufactured medicines, or in instances when pain medication or narcotics are not advised by a physician. Tricare’s May 1 restriction on compounding medications made it virtually impossible for specialty pharmacies to fill these physician-prescribed treatments for veterans.

In late June, six congressmen submitted a letter asking the assistant secretary of Defense for Health Affairs to review Tricare’s actions saying, “While these changes were created with good intent, they have ultimately removed all access of compounded medications from patients.”

Tricare’s actions seemed to say patients with special medicinal needs, namely our active-duty and U.S. veterans, were going to have to find a new solution. Unfortunately, specialty medications were the gap stop in these incidences, leaving no other viable solution.

As with all good stories, there are two sides here. Tricare had reason to scrutinize some compounding pharmacy operations due to the manner in which they marketed their products; these bad-actor groups gave the well-intentioned and physician-supported industry a besmirched reputation.

While Tricare has the right — and the responsibility — to investigate any practice that is in the best interest of their constituency and budget, the group should not have the right to take a detrimentally sweeping action that causes real pain to veterans, physicians and pharmacies acting according to Food and Drug Administration regulations and medical best practices.

Specialty pharmaceuticals, or compounded medications, provide much-needed assistance for patients who are unable to experience results from mass-produced pharmaceuticals, for any number of reasons. If a patient is allergic to dye, the components disrupt the digestive system, a tendency towards opiate addiction exists, or the ratio of components is not effective, a physician will recommend FDA-approved components to formulate a specialized medication that is best-suited for the patient.

Since May 1, Tricare has not allowed for compounded prescriptions to be filled by barring reimbursements.

That’s 131 days a woman who fought for U.S. freedom has not had the pain cream that she needs to ease the sting of her battle wounds. That’s 130 days a grandfather has not had his compounded high-dose Vitamin B capsules that help him stay alert and play with his grandchildren; he missed raising his children while on tour in Afghanistan, now he cannot be active with his grandchildren because his medicine is unaffordable.

Veterans fearlessly gave the prime of their lives to serve this country. Don’t let a few bad actors in the field bar veterans seeking medical support under advisement from their physicians from having the care that they need and deserve.

Do we need to tighten the budget? Let’s cut the fat in an area that doesn’t leave veterans in pain. They deserve better from us.

Matthew S. Smith, vice president of operations at Patient Care America, is a licensed pharmacist with more than 24 years of experience managing and operating national home infusion and specialty pharmacies.