5 June 2014 Legislative News Update 

6/5/2014 

weekly electronic newsletter, and is published
every Monday when Congress is in session.




In this issue:

  • Senate Bill Would Hike Drug Copays
  • Compromise Reached on VA Legislation

★★★

SENATE BILL WOULD HIKE DRUG COPAYS

We reported last week that the Senate Armed Services Committee’s version of the fiscal 2015 defense authorization bill includes provisions that would drastically alter the military’s pharmacy program. 

The bill, as it currently stands, would alter the pharmacy program in three ways. 

First, the pilot program that requires all TRICARE-For-Life beneficiaries to refill maintenance medications either through mail order or at a military treatment facility for one year would be expanded to include all TRICARE beneficiaries. 

Second, drugs not included in TRICARE’s formulary would only be available through mail order or a military treatment facility.  They would no longer be attainable through retail pharmacy outlets. 

Third, the provision would increase pharmacy copays.  The chart below illustrates the proposed copay changes.

ONE MONTH SUPPLY OF DRUGS FROM A RETAIL OUTLET

 

Current

FY15

FY16

FY17

FY18

FY19

FY20

FY21

FY22

FY23

FY24

Generic

$5

$5

$6

$7

$8

$9

$10

$11

$12

$13

$14

Brand

$17

$26

$28

$30

$32

$34

$36

$38

$40

$43

$45

Non-Formulary

$44

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

THREE MONTH SUPPLY OF DRUGS THROUGH MAIL ORDER

 

Current

FY15

FY16

FY17

FY18

FY19

FY20

FY21

FY22

FY23

FY24

Generic

$0

$0

$6

$0

$0

$9

$10

$11

$12

$13

$14

Brand

$13

$26

$28

$30

$32

$34

$36

$38

$40

$43

$45

Non-Formulary

$43

$51

$54

$58

$62

$66

$70

$75

$80

$85

$90

Drugs obtained from a military treatment facility would remain free of charge.

Last year’s National Defense Authorization Act directed that copays for prescriptions would be increased annually by only the same percentage as retiree cost of living adjustments.  In years when a COLA increase would total less than a dollar, it will be delayed a year and combined with the next adjustment so increases will always be $1 or more.

We believe last year’s increases are more than enough.

COMPROMISE REACHED ON VA LEGISLATION?

Competing legislation pertaining to the Department of Veterans’ Affairs, specifically, ways to “fix” it, are making the rounds on Capitol Hill this week. 

Chairman of the Senate Veterans’ Affairs Committee Bernie Sanders, I-Vt., has introduced a bill, the Restoring Veterans’ Trust Act of 2014 that would give the VA authority to immediately remove senior executives based on poor job performance while preventing wholesale political firings. 

Other provisions in Sanders’ bill would provide veterans who can’t get timely appointments with VA doctors the option of going to community health centers, military hospitals or private doctors.  It would authorize VA to lease 27 new health facilities in 18 states and authorize emergency funding to hire new doctors, nurses and other providers in order to address system-wide health care provider shortages and to take other steps necessary to ensure timely access to care.  To address primary care doctor shortage for the long-term, the bill would authorize the National Health Service Corps to award scholarships to medical school students and to forgive college loans for doctors and nurses who go to work at the VA.

On the other side of the aisle, Sens. John McCain, R-Ariz., Jeff Flake, R-Ariz., Tom Coburn, R-Okla., and Richard Burr, R-N.C., have introduced the Veterans Choice Act that would allow all veterans enrolled for care at VA to receive a Choice Card enabling them to receive care from a non-VA provider.

The legislation also:

§  Directs VA to publish on each VA medical center (VAMC) website the current wait time for an appointment, current wait-time goals, and to improve their “Our Providers” link to include where a provider completed their residency and whether the provider is in residency.

§  Directs VA to establish a publicly-available database of patient safety, quality of care, and outcome measures.

§  Directs VA to report to the Department of Health and Human Services the same patient quality and outcome information as other non-VA hospitals.

§  Directs Veterans Health Administration to provide veterans with the credentials of a provider prior to surgery.

This bill would also give the VA Secretary the authority to demote or fire Senior Executive Service employees based on performance.

Over on the House side, a bill introduced by Veterans Committee Chairman Jeff Miller, passed on a 390-33 vote.  The VA Management Accountability Act gives the VA secretary authorization to dismiss senior executives or demote them to the civil service.  It would require the VA secretary to notify Congress of such a firing or demotion within 30 days.  Similar legislation was offered by Sens. Marco Rubio, R-Fla., and Lamar Alexander, R-Tenn.

AUSA supports any bi-partisan legislation that fixes the widely-reported problems within the VA system.  A report released by the VA inspector general found a systemic problem nationwide in scheduling veterans for health care in a timely manner, including instances where VA staff falsified records to cover up long waits.