In the wake of the access crisis that rocked the VA health care system last spring, the VFW has compiled a series of reports on the state of VA health care and to evaluate the implementation of important reforms created by the Veterans Access, Choice, and Accountability Act.
The law included significant reforms designed to offer veterans new options to receive timely, quality health care. The law also included emergency funding to help build capacity within the Department of Veterans Affairs health care system and new authorities allowing the VA secretary to more easily reprimand executive employees.
The VFW first issued a report entitled “Hurry Up and Wait,” to evaluate the state of the VA health care system and identify persistent challenges and potential solutions to ensure VA can deliver quality, timely care to all veterans who have earned it. However the VFW’s work did not end there.
After reforms were implemented, the VFW commissioned several surveys to gauge veteran’s experiences and evaluate the law’s most significant reform, the Veterans Choice Program. The VFW has analyzed input from more than 9,600 veterans regarding their satisfaction and access to the new program, through which veterans waiting more than 30 days for care or residing more than 40 miles from a VA medical facility are offered an opportunity to receive care from non-VA providers.
The VFW’s initial Veterans Choice Program report included six specific recommendations regarding participation, wait-time standard, geographic eligibility, and non-VA care issues that needed to be addressed. Fortunately, the program has also remained a top priority for VA and Congress, which have addressed several issues that accompanied the program’s roll-out.
The VFW continues to play an integral part in identifying issues the Veterans Choice Program faces and recommending reasonable solutions to such issues. On March 11, 2015, the VFW published its third report in its series of reports on the state of the VA health care system and the Veterans Choice Program. The report includes 13 recommendations on how to improve the Veterans Choice Program and VA’s purchased care model to ensure they serve the best interest of America’s veterans.
As of May 1, the VFW has heard on this issue from more than 9,600 veterans throughout the country. VFW is available to offer direct intervention on behalf of all veterans experiencing problems accessing care via VFW’s national helpline 1-800-839-1899 or email firstname.lastname@example.org. To read “Hurry Up and Wait” and VFW’s initial, and second report on the Veterans Choice Program, visit https://www.vfw.org
DOJ secures $60M in refunds
The Department of Justice has secured $60 million in refunds for military veterans it contends were illegally charged too much interest on their student loans. The student loan service provider formerly known as Sallie Mae, which has since changed its name to Navient Corp., will begin issuing the refunds next month to 77,795 veterans who were overcharged for their educations. Navient agreed last year to settle DOJ charges that it violated the Servicemembers Civil Relief Act (SCRA) by not capping interest rates for certain loans to veterans at 6 percent. The company will begin sending the refunds out next month. Navient disputed the charges from DOJ and says it maintains a commitment to serving veterans.
A medical best practice
A prior authorization (or preauthorization) is an approval for a prescribed procedure, health care service or medication before you receive the care. If you’re enrolled in a TRICARE Prime plan, your primary care manager (PCM) will work with your regional contractor for the prior authorization. For all other plans, you need to contact your regional contractor for prior authorization. TRICARE uses prior authorization as a tool to ensure safety and efficiency in both the medical and pharmacy benefit.
Prior authorization is a standard process used routinely by not only TRICARE but also other commercial and government health plans, like Medicare. Getting prior authorization ensures that some types of non-routine care are both appropriate for the patient and cost effective. In some cases, there may be an equally effective treatment or therapy available at a lower cost. This type of checks and balance for TRICARE helps lower the cost of care for everyone, and keeps the benefit sustainable for future generations of the military community.
Each TRICARE region contractor has their own process on how prior authorizations are managed. You can see a list of services that require prior authorization on the TRICARE website at http://tricare.mil/FindDoctor/Appointments/Authorization. The site also has links to the regional contractor websites to see region-specific requirements.
TRICARE also recently implemented prior authorization for some compound drugs that contain ingredients not proven safe and effective. Compound drugs are a combination of two or more drug ingredients made specifically by your pharmacist to meet your individual needs. The prior authorization allows your doctor to submit additional evidence that the ingredients in your compound drug are safe and effective, and to show that commercially available drugs aren’t appropriate for you. This ensures that even though compound drugs can be an expensive form of therapy, they are available to patients who really need them. Your doctor can contact Express Scripts to request a prior authorization for compound drugs.