Phyllis Ramm, the wife of an Air Force retiree, got a surprise Aug. 7 when she called the Keesler Air Force Base pharmacy to refill routine prescriptions.
She learned that some popular brand-name drugs no longer would be dispensed on base after patients were given a final 30-day supply.
The Air Force directed its 74 pharmacies in July to drop Allegra, for allergy relief, and Celebrex, for arthritis pain, from their formulary, and to recommend instead lower-cost alternatives of equal effectiveness.
Patients using Allegra, a nondrowsy antihistamine, can take a generic form of Claritin instead, said Maj. Gen. Joseph Kelley, Air Force assistant surgeon general, in a July memo to commands. Users of arthritis inhibitors Celebrex and Bextra are being switched to Vioxx. Patients using the insulin Humalog will be offered Novolog instead.
The changes, meant to control spiraling drug costs without sacrificing patient care, reflect “an extremely challenging budget year for the Air Force Medical Service,” Kelley said.
The change has upset some patients, including Phyllis Ramm’s husband.
“My feeling is that our entitlement, of which pharmaceutical service is a part, is being chipped away,” said retired Chief Master Sgt. Charles Ramm, of Gautier, Miss.
Air Force pharmacies are only the first to tighten drug inventories in this way. The Army and Navy are expected to make similar moves this fall, during a more formal process to shape a uniform formulary.
Cmdr. Leisa Richardson, with the Navy pharmacy directorate, said her service developed the changes adopted by the Air Force.
“We would like to see these cost-savings initiatives become tri-service,” she said.
“Frankly, the Air Force kind of caught us all flat-footed,” said another service official.
The Air Force was forced to act to control costs, said Col. Phil Samples, pharmacy consultant to the Air Force surgeon general. Although the service has known since October that its wartime medical budget for 2004 was tight, costs are rising faster than expected. Air Force base pharmacy costs on the 100 most popular drugs is up a projected $38.3 million over last year, and not all of that is budgeted, Samples said.
Lt. Col. David Bobb, deputy to the surgeon general for medical support, operations and policy, said the Air Force tightened drug formularies only after reducing spending on medical equipment and supplies, and found that wasn’t enough. Remaining choices were few, he said.
“We certainly don’t want to have to close any facilities before the end of the fiscal year,” Bobb said.
The decision drew criticism from service associations and veterans groups, who expect to have a formal role starting this fall in developing a uniform formulary for drugs offered through Tricare retail outlets and the Tricare mail-order program.
Bob Washington of the Fleet Reserve Association, who will serve on the beneficiary panel, said the Air Force’s change in the base pharmacy formulary last month looks like an attempt to “circumvent” this process.
Air Force officials said they worried about that perception, but still needed to act.
The Military Coalition, a group of service and veterans associations, complained of the formulary shift in a July 26 letter to Lt. Gen. George Taylor, Air Force surgeon general. The Air Force, it said, is risking higher drug costs if more patients use the Tricare retail network, where costs are higher for the government and patients. Also, while the Air Force takes credit for standardizing its own base formulary, the changes have created “regrettable interservice disparities,” the letter said.
One coalition representative said the Army and Navy can’t be thrilled by the prospect of filling Allegra and Celebrex prescriptions for Air Force beneficiaries, which will aggravate their own budget challenges.
Samples said he hopes patients instead try replacement medicines, the generic version of Claritin, for example, which costs the military pharmacies 7 cents a pill, versus Allegra, which costs 96 cents.
To comment, write Military Update, P.O. Box 231111, Centreville, VA, 20120-1111, e-mail milupdate@aol.com or go to www.militaryupdate.com.
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