"Federal Healthcare Programs"

[Zhoen]

Question-- there's all these AWESOME prescription-transfer incentives out there, but they all say they exclude "any prescription paid for in whole or in part by state or federal healthcare programs."

Anybody tried this with Tricare/Healthnet? I mean, we're federal employees, but I *THINK* it's a private company, yes/no?

Obviously this makes sense that if something is funded by the government directly, then incentives are kickbacks/bribes, and therefore illegal... but is Tricare a "federal healthcare program" or are they talking more for medicaid-type programs?

 

[msmayor]

I can't say for sure, but I truly doubt Tricare is considered a private company. Their website uses a .mil extension and a big "Department of Defense" logo. That screams federal government to me.

 

[Zhoen]

Well, pooey

 

[JB2K]

Question-- there's all these AWESOME prescription-transfer incentives out there, but they all say they exclude "any prescription paid for in whole or in part by state or federal healthcare programs."

Anybody tried this with Tricare/Healthnet? I mean, we're federal employees, but I *THINK* it's a private company, yes/no?

Obviously this makes sense that if something is funded by the government directly, then incentives are kickbacks/bribes, and therefore illegal... but is Tricare a "federal healthcare program" or are they talking more for medicaid-type programs?

It won't work as Tricare (contracted-out to Express Scripts), being a federal healthcare program, is very much considered part of that little caveat (as is Medicare, Medicaid, etc.)

A good example is Target's pharmacy rewards program -- Tricare beneficiaries cannot accrue prescription fills towards that additional 5% off certificate...

 

[LadyBeBop]

Zhoen, thank you for starting this thread.

I'm a federal employee, and this is a hot topic for me.

My health care provider is Blue Cross/Blue Shield through the Federal Employee Program. DH and I uses CVS as our pharmacy. We have about eight prescriptions a month (I'm type 2 diabetic), and we're supposed to get one extra care buck for every two prescriptions filled.

But we don't get it. Because I'm a federal employee who uses its health care.

I understand not getting a benefit if I was on Medicare or Medicaid or some other government program. But this is a typical employee health care system. It's same if I was a private sector employee.

To me, it's not fair.

 

[Zhoen]

I admit, it doesn't thrill me either, but I understand how it would seem to "Joe Average." It was only in the last decade or so that we are able to accrue air miles-- those used to be considered bribes as well. People get very touchy about anything "government."

Since the last prescription I had filled would have cost $300 for cash, but ExpressScripts only paid about $15, maybe the businesses don't allow the incentives because they'd lose money on us?

 

[LadyBeBop]

Since the last prescription I had filled would have cost $300 for cash, but ExpressScripts only paid about $15,

Is $15 your out-of-pocket, or is that actually the amount ExpressScripts paid to your pharmacy?

maybe the businesses don't allow the incentives because they'd lose money on us?

Pharmacies aren't in the business to lose money. And they wouldn't be losing money if we Feds could participate in their prescription savings programs. For instance, CVS's ECBs. If I could spend an additional $4/mo in ECB's at CVS, I'd buy more of the medicines and health and beauty goods at CVS rather than the grocery store next door.

 

[Zhoen]

I paid $0 out of pocket, Tricare paid $15, the rest was a write off. I was FLOORED. I don't believe the meds really cost $300 to the make, but that was the billing sum, so the pharmacy could write-off the other $285 as a "loss"... I started a thread asking about it, and it's all reallllyyy shady.

 

[blueVW]

I paid $0 out of pocket, Tricare paid $15, the rest was a write off. I was FLOORED. I don't believe the meds really cost $300 to the make, but that was the billing sum, so the pharmacy could write-off the other $285 as a "loss"... I started a thread asking about it, and it's all reallllyyy shady.

Actually, it is not a loss, but a "contractual adjustment." If the pharmacy has a contract with your Rx insurance company they must accept what your insurance company "allows" - in this case it was $15.00, and write off the remaining balance. The insurance company dictates to the pharmacy the allowed amount, patient responsibility amount, and the write off amount. The write off is a contractual adjustment that cannot be claimed as a loss by the pharmacy.

I am a medical billing manager and do agree there is lots of shady stuff that goes on with the pharmaceutical industry...

 

[lost*in*cyberspace]

I paid $0 out of pocket, Tricare paid $15, the rest was a write off. I was FLOORED. I don't believe the meds really cost $300 to the make, but that was the billing sum, so the pharmacy could write-off the other $285 as a "loss"... I started a thread asking about it, and it's all reallllyyy shady.

The cost of medication doesn't just cover the actual cost of production. Much of the cost goes to cover research and development, and these costs are borne more by US consumers than consumers in the rest of the world. Good explanation here:

http://www.medicinenet.com/script/main/art.asp?articlekey=18892

http://washingtonoutside.blogspot.com/2011/06/costs-of-prescription-drugs.html

 

[nicolepitts]

Zhoen, thank you for starting this thread.

I'm a federal employee, and this is a hot topic for me.

My health care provider is Blue Cross/Blue Shield through the Federal Employee Program. DH and I uses CVS as our pharmacy. We have about eight prescriptions a month (I'm type 2 diabetic), and we're supposed to get one extra care buck for every two prescriptions filled.

But we don't get it. Because I'm a federal employee who uses its health care.

I understand not getting a benefit if I was on Medicare or Medicaid or some other government program. But this is a typical employee health care system. It's same if I was a private sector employee.

To me, it's not fair.

I just notice my target scripts not going towards my rewards today. I called and they said they are looking into my account. But now I am depressed. We pay our portion for health care just like a private sector plan? I am upset if they aren't going to fix it. I went there for the rewards program specifically. It's not convenient and I will transfer to Walgreens or Cvs which are closer and have a drive through . Which means less money I will spend in target while
Browsing.

 

[worm761]

I did not know this. DH is a federal employee so we ar BC/BS FEP too. This totally sucks!

 

[dsneprincess]

Due to my job, I know for a fact that the reason this is excluded is due to the government specifically excluding their employees from this. All federal employer payers (tricare, bcbs federal employee, etc.) use the same payor rules, purchasing discounts, contracts, rebates, reimbursements as medicare d/medicaid. This is the governments rules, not CVS, Walgreen's, Target, etc. I would bet more of the medicaid/medicare rules will be implemented on federal programs. Don't be mad at the private companies, the federal government is making the rules. BTW, has nothing to do with the reimbursement model.

 

[sharon_wv]

I also work for the federal govt and have blue cross as well. I think we are in eligible because part of the premium is paid for by the govt. therefore Ineligible for perks. It bums me out too. Its not as if i am not paying a boatload in premium out of my pocket Before I worked for the govt I enjoyed transferring prescriptions and that sort of thing.

 

[nicolepitts]

What bothers me is a lot of employers pay a part of their employees premiums. It's not like we signe up for government programs.

 

[mrsbornkuntry]

What bothers me is a lot of employers pay a part of their employees premiums. It's not like we signe up for government programs.

While this is true I think the premiums that government employees pay (my DH included) is considerably less than what they pay in the private sector. I am basing this off of other "what do you pay for health insurance" threads.

 

[jsmith]

We pay 195 dollars a month for Tricare Reserve select vs 1260 a month that our share of my civilian employers health plan would be-i would have to accumulate one heck of a lot of retail pharmacy points to off set that-and that fact that we fill most basic scrips on post at no cost to us AND when we do pay for them off post the co-pays are so low. Based on monthly perscriptions and savings i would need to get about 1200 a month in credits and points-ill take the 195 a month and no discounts thanks.

 

[mrsbornkuntry]

We pay 195 dollars a month for Tricare Reserve select vs 1260 a month that our share of my civilian employers health plan would be-i would have to accumulate one heck of a lot of retail pharmacy points to off set that-and that fact that we fill most basic scrips on post at no cost to us AND when we do pay for them off post the co-pays are so low. Based on monthly perscriptions and savings i would need to get about 1200 a month in credits and points-ill take the 195 a month and no discounts thanks.

We pay considerably more than that for federal BCBS, but it's still considerably lower than civilian. Plus DH is deployed so now we have Tricare Standard and BCBS and the government is paying for both of them until he's off active duty. I'm definitely not complaining.

 

[sharon_wv]

I pay about 300 a month for bc/bs basic for my family. It is a LOT more than what I paid in private industry (which was less than 200 a month for family coverage). My insurance plan with my industry employer had significantly better coverage as well.

But when I switched from contractor to fed, I did it primarily for job security, which I hope if have even if sequestration goes into effect in january.

 

[nicolepitts]

Sharon we pay quite a bit more than we did privately as well. I also know people pay more then we do now. It just seems to be broad stroking federal employees. I understand federal programs not being included and even Trieste. But we pay and have the same setup as everyone else. Why wouldn't I expect to get the same rewards as others?

It makes me sad. Target is suppose to call me back Monday but I don't expect anything good. I do plan to lodge a complaint. Especially since they signed me up at the pharmacy, and they should have known/ informed me about my insurance. It's clear it's federal on my card