Latest news with #Tricare
Yahoo
4 days ago
- Business
- Yahoo
Tricare errors put military families at risk of paying higher costs, audit finds
Tricare, the federal health-insurance program for military service members and their families, and the Defense Health Agency that governs it, put beneficiaries at risk of paying much higher costs due to a lack of internal controls, according to an audit conducted by the Department of Justice. The audit by the Inspector General reviewed financial records across both Tricare's East and West regions (which includes all 50 states) from November 2023 to February 2025, found that policy did not require federal officials or the company to ensure that rates for services or equipment that don't already have a defined reimbursement rate were 'reasonable or consistent with other states,' and contractors did not have guidance on how to create new rates. This caused a contractor in Illinois to pay $11,500 for custom sleep apnea mouth guards, a price 283% higher than the cost in neighboring Iowa, according to the audit report. The DHA also allowed rental costs for medical items to far exceed the cost of purchasing, resulting in a contractor paying Tricare $5,000 per month to rent one of two compression devices while the same product was available to rent for $675 per month and another supplier was selling one for $409.50. Virginia is among the states with higher rental rates than purchasing costs. For a particular compression device, the rental cost per month in Virginia was $4,680 compared to $3,450 to buy it, a 35.7% difference. Connecticut had the highest difference at 100.2%, according to the audit. In fiscal year 2023, Tricare contractors paid a total of $183 million for items or services that didn't have a defined reimbursement rate. It's unclear how much of that total is considered 'unreasonable' and how much additional financial burden was passed on to beneficiaries. 'Because the DHA did not determine that the state prevailing rates were reasonable, the DoD is at risk of wasteful spending and increasing DoD beneficiaries' risk of unreasonable cost-shares for health care services and items that are paid with state prevailing rates,' the audit concludes. State prevailing rates are established by taking all the billed charges for a service or item in the previous year and separating them by state. The state prevailing rate is then set at the 80th percentile of the charges for that service or item in each state. The amount the DHA has reimbursed providers for all health care services and items has decreased by 16% since fiscal year 2021 as a result of measures taken in response to prior DOD reviews, according to the audit. The federal agency issued a policy in July that allows contractors to set payment thresholds to 'prevent reimbursement substantially in excess of customary or reasonable charges.' The Inspector General recommends that the DHA reassess and revise the state prevailing rates in Tricare's policy to ensure rates are 'reasonable,' develop and issue guidance to require an independent party to review the state prevailing rates annually, and implement an oversight mechanism. DHA has hired a company to monitor the accuracy of payments made by Tricare contractors. In 2022 and 2023, this company found that Tricare had a quarterly error rate of 0.31% or less and 0.4% or less, respectively, across both the East and West regions. These error rates are lower than Tricare's own maximum allowable error rate of 1.75%. A Tricare spokesperson did not respond to an emailed question about how soon beneficiaries might see a change in costs.
Yahoo
22-05-2025
- Health
- Yahoo
Trump's IVF report generates buzz and caution ahead of release
A highly anticipated White House report about in vitro fertilization (IVF) and infertility that could make sweeping recommendations on making the procedure more accessible is now in the hands of President Trump and may be released soon. Representatives from IVF advocacy groups, for-profit clinics, and conservative think tanks have been meeting regularly with administration officials since February, when Trump signed an executive order calling for a menu of recommendations to improve IVF access. The White House said the report was delivered to the president Monday, and he is reviewing it. 'The Domestic Policy Council has worked closely with external stakeholder groups over the past 90 days to deliver on President Trump's executive order to formulate a plan on expanding IVF access for American families,' administration spokesperson Kush Desai said in a statement to The Hill. 'This is a key priority for President Trump, and the Domestic Policy Council (DPC) has completed its recommendations,' Desai added. The White House didn't offer details about the contents of the report or when it will be released. But industry representatives and fertility doctors who participated in meetings with the White House said they came away feeling optimistic about what the report could recommend. Senior administration officials — including White House chief of staff Susie Wiles and Vince Haley, head of the DPC — seemed engaged, they said, and well-versed on fertility issues. Some of the ideas presented included mandating Tricare insurance to cover IVF for military members and declaring IVF an 'essential health benefit' under the Affordable Care Act (ACA), so all ACA exchange plans must cover it. Some of the actions can be done with an executive order, while others may need congressional intervention. 'I would say, if anything, I was encouraged by the meeting. Sometimes you walk into these meetings and people on the other side have a preconceived idea what they want,' but that didn't seem to be the case, said TJ Farnsworth, president of the Fertility Providers Alliance. Farnsworth said he met with White House officials in March. Kaylen Silverberg, a fertility clinic doctor from Texas and chair of the advisory board of Americans for IVF, said he's been in regular contact with officials about how best to expand access to IVF. 'At every single level, at every single conversation, I've been floored by how serious they all are and by how well-informed they are,' Silverberg said. 'I had very objective high-level [discussions] drilling down to low-level in-the-weeds questions.' Americans for IVF is a conservative group that promotes expanded access to IVF as a 'pro-family' and 'pro-life' issue. 'I am optimistic, highly optimistic, that this administration is taking this issue more seriously than any other administration I've been in contact with,' Silverberg said. Trump's executive order called for a report with recommendations to protect access and 'aggressively' reduce 'out-of-pocket and health plan costs for IVF treatment.' The average cost for one cycle of IVF is about $15,000, and many patients require multiple cycles before a successful pregnancy is achieved. Trump vowed during the 2024 presidential campaign that he would ensure IVF treatments would be covered by the government or that the government would require insurance companies to cover it. Such a move would almost certainly drive up health insurance costs. IVF became a campaign issue after a 2024 Alabama Supreme Court ruling that frozen embryos should be considered as children and therefore discarding them is criminal. The ruling temporarily halted IVF services for many patients in Alabama. Trump and other Republicans quickly distanced themselves from the ruling and talked about their support for IVF. Though Republicans hadn't directly opposed IVF access, Democrats tried to tie the issue to abortion. But his executive order did not make any policy recommendations or endorsements. That's tempering expectations for what could come from the proposal. 'I think [the order] created a lot of buzz and excitement,' Farnsworth said. 'But there's not any certainty in what was said, except that it's asking for proposals. And where those proposals go, it's hard to know.' Still, he added that even if the report recommends incremental change, it would move IVF policy forward. 'It's really encouraging that there is a U.S. president that's even talking about this,' Farnsworth said. Infertility remains a common problem among Americans, and many insurance companies or employers don't cover the costs. Yet other conservative groups that have the ear of the White House are less supportive of broad IVF coverage mandates. The Heritage Foundation, for instance, wants tighter regulation of the IVF industry and a focus on 'restorative reproductive medicine.' The idea is to treat the root cause of infertility directly, rather than try to circumvent it with a medical intervention like IVF. Assisted reproductive technology should be a last resort, the group says. Anti-abortion Christians also oppose IVF because they view embryos as humans, a position that has put many Republicans in a bind, given IVF clinics regularly dispose of unused embryos. Silverberg said he understands the White House has been soliciting many opinions, but he hopes the report will reflect medical perspectives. However, two of the primary advocacy groups representing medical providers and patients said they were not involved in the process. 'Over the last 10 years, we have led efforts in the states that have led to improved coverage for 60 million people, but for some reason, this White House doesn't want to talk to us,' said Sean Tipton, chief advocacy and policy officer of the American Society for Reproductive Medicine. Tipton said his organization reached out to White House officials through emails and letters but never heard back. Another group, Resolve: The National Infertility Association, also was not involved in the report, the group's CEO Barbara Collura said. 'There are so many ways that this could go. It could be that the White House decides to study this more. It could be that the White House finds a small sector of coverage that they want to work on and that's it,' she said. 'Look, I have the President's promise on the campaign trail, we have the executive order, and that's all I have to go on right now.' Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
The Hill
22-05-2025
- Health
- The Hill
Trump's IVF report generates buzz and caution ahead of release
A highly anticipated White House report about in vitro fertilization (IVF) and infertility that could make sweeping recommendations on making the procedure more accessible is now in the hands of President Trump and may be released soon. Representatives from IVF advocacy groups, for-profit clinics, and conservative think tanks have been meeting regularly with administration officials since February, when Trump signed an executive order calling for a menu of recommendations to improve IVF access. The White House said the report was delivered to the president Monday, and he is reviewing it. 'The Domestic Policy Council has worked closely with external stakeholder groups over the past 90 days to deliver on President Trump's executive order to formulate a plan on expanding IVF access for American families,' administration spokesperson Kush Desai said in a statement to The Hill. 'This is a key priority for President Trump, and the Domestic Policy Council (DPC) has completed its recommendations,' Desai added. The White House didn't offer details about the contents of the report or when it will be released. But industry representatives and fertility doctors who participated in meetings with the White House said they came away feeling optimistic about what the report could recommend. Senior administration officials — including White House chief of staff Susie Wiles and Vince Haley, head of the DPC — seemed engaged, they said, and well-versed on fertility issues. Some of the ideas presented included mandating Tricare insurance to cover IVF for military members and declaring IVF an 'essential health benefit' under the Affordable Care Act (ACA), so all ACA exchange plans must cover it. Some of the actions can be done with an executive order, while others may need congressional intervention. 'I would say, if anything, I was encouraged by the meeting. Sometimes you walk into these meetings and people on the other side have a preconceived idea what they want,' but that didn't seem to be the case, said TJ Farnsworth, president of the Fertility Providers Alliance. Farnsworth said he met with White House officials in March. Kaylen Silverberg, a fertility clinic doctor from Texas and chair of the advisory board of Americans for IVF, said he's been in regular contact with officials about how best to expand access to IVF. 'At every single level, at every single conversation, I've been floored by how serious they all are and by how well-informed they are,' Silverberg said. 'I had very objective high-level [discussions] drilling down to low-level in-the-weeds questions.' Americans for IVF is a conservative group that promotes expanded access to IVF as a 'pro-family' and 'pro-life' issue. 'I am optimistic, highly optimistic, that this administration is taking this issue more seriously than any other administration I've been in contact with,' Silverberg said. Trump's executive order called for a report with recommendations to protect access and 'aggressively' reduce 'out-of-pocket and health plan costs for IVF treatment.' The average cost for one cycle of IVF is about $15,000, and many patients require multiple cycles before a successful pregnancy is achieved. Trump vowed during the 2024 presidential campaign that he would ensure IVF treatments would be covered by the government or that the government would require insurance companies to cover it. Such a move would almost certainly drive up health insurance costs. IVF became a campaign issue after a 2024 Alabama Supreme Court ruling that frozen embryos should be considered as children and therefore discarding them is criminal. The ruling temporarily halted IVF services for many patients in Alabama. Trump and other Republicans quickly distanced themselves from the ruling and talked about their support for IVF. Though Republicans hadn't directly opposed IVF access, Democrats tried to tie the issue to abortion. But his executive order did not make any policy recommendations or endorsements. That's tempering expectations for what could come from the proposal. 'I think [the order] created a lot of buzz and excitement,' Farnsworth said. 'But there's not any certainty in what was said, except that it's asking for proposals. And where those proposals go, it's hard to know.' Still, he added that even if the report recommends incremental change, it would move IVF policy forward. 'It's really encouraging that there is a U.S. president that's even talking about this,' Farnsworth said. Infertility remains a common problem among Americans, and many insurance companies or employers don't cover the costs. Yet other conservative groups that have the ear of the White House are less supportive of broad IVF coverage mandates. The Heritage Foundation, for instance, wants tighter regulation of the IVF industry and a focus on 'restorative reproductive medicine.' The idea is to treat the root cause of infertility directly, rather than try to circumvent it with a medical intervention like IVF. Assisted reproductive technology should be a last resort, the group says. Anti-abortion Christians also oppose IVF because they view embryos as humans, a position that has put many Republicans in a bind, given IVF clinics regularly dispose of unused embryos. Silverberg said he understands the White House has been soliciting many opinions, but he hopes the report will reflect medical perspectives. However, two of the primary advocacy groups representing medical providers and patients said they were not involved in the process. 'Over the last 10 years, we have led efforts in the states that have led to improved coverage for 60 million people, but for some reason, this White House doesn't want to talk to us,' said Sean Tipton, chief advocacy and policy officer of the American Society for Reproductive Medicine. Tipton said his organization reached out to White House officials through emails and letters but never heard back. Another group, Resolve: The National Infertility Association, also was not involved in the report, the group's CEO Barbara Collura said. 'There are so many ways that this could go. It could be that the White House decides to study this more. It could be that the White House finds a small sector of coverage that they want to work on and that's it,' she said. 'Look, I have the President's promise on the campaign trail, we have the executive order, and that's all I have to go on right now.'
Yahoo
19-05-2025
- Health
- Yahoo
Nearly a third of Americans aren't filling their prescriptions because of high costs
Healthcare professionals write millions of prescriptions every year to help Americans manage symptoms and treat a range of conditions. But affordability, access issues, and drug shortages prevent people from actually filling these prescriptions. GoodRx Research ran a 12-month survey to better understand the dynamics that shape prescription medication fills and consumer behavior. The following insights come from this survey of nearly 12,000 Americans. The findings highlight the significant financial and accessibility challenges people with and without insurance face in filling their prescriptions. According to a GoodRx Research survey, 29% of Americans leave prescriptions for medications unfilled due to cost. Cost is a barrier for people with and without insurance. Yet most patients don't talk about medication affordability with their prescriber. Drug shortages prevent 26% of Americans from accessing their prescribed medications. This includes access to essential medications like Ozempic, insulins, and some antibiotics. Unfilled prescriptions present serious health risks and long-term healthcare expenses. According to the GoodRx survey, 33% of Americans (52 million if extrapolated to the general population) had a prescription sent to the pharmacy that was ultimately not filled. So why aren't people filling these prescriptions? Medication cost is the main reason. People also forget to pick up their medications. Timing is another big issue. When people do go to the pharmacy, their medication may be out of stock. And many people just can't get to the pharmacy in time. This finding is alarming given that nonadherence, or not taking a medication as prescribed, can worsen chronic conditions. The high cost of medications can force people to make difficult choices between prioritizing their health and managing other essential expenses. In turn, this can lead to poor health outcomes and increased costs in the long run. Medication cost is the leading cause of unfilled prescriptions in the U.S. And this is an issue that affects people with and without health insurance. In fact, nearly a quarter of Americans are unable to fill their medication because their insurance doesn't cover it. When insurance doesn't cover a medication, patients are often on the hook for the full price. They may face financial strain and, ultimately, gaps in treatment and worsening symptoms. As it turns out, individuals who rely on the Affordable Care Act health exchange insurance plans have poorer coverage compared to other plan types. Among those on health exchange plans, 34% report a lack of prescription coverage. People with Tricare, Veterans Affairs (VA) insurance, or other military insurance have the highest rates of prescription coverage. GoodRx Research found that 23% of people spent more than $50 on their prescriptions per month (after removing respondents with Medicaid coverage). And nearly 10% reported spending over $100 on their prescriptions in the most recent month. And, once again, people with a health exchange plan, no insurance, or private insurance seem to pay more out of pocket on their prescriptions each month. Costs vary a lot for people with exchange plans. Only 19.7% pay nothing out of pocket and 2.9% pay $200 or more per month. This group, along with those enrolled in private insurance, appear to have the worst coverage for prescription medications. A substantial portion of their out-of-pocket costs falls into the mid-to-high cost brackets. Medicaid recipients, on the other hand, appear to have the most comprehensive prescription coverage. This finding is a reminder that prescription affordability will remain a barrier to medication adherence concern for many Americans until costs come down or insurance coverage improves. Research shows that patients want to talk about cost with their physicians, but few are actually doing so. The GoodRx survey of American adults found that only 42% were having these conversations. And given that cost is a barrier to filling prescriptions, cost conversations should happen every time medications are prescribed. While some Americans can't afford their medications, 26% can't access their medication at all due to shortages. Among the drugs that people are struggling to access are Ozempic, Trulicity, Zepbound, Mounjaro, Losartan, Adderall, and some antibiotics. Factors contributing to shortages may include increased demand, supply chain issues, and manufacturing delays. The survey was run through YouGov, in three waves. The survey ran monthly from February 2024 through January 2025. In each wave, GoodRx collected 1,000 responses. Survey responses were weighted to the U.S. population using age, gender, race, political affiliation, and education level. The YouGov survey research arm provides more information. To estimate the number of Americans who left a prescription at the pharmacy each month, the survey's incidence rate was multiplied by the percentage of respondents who reported leaving at least one prescription at the pharmacy. This product was then multiplied by the total number of American adults, based on data from the 2019 American Community Survey. This story was produced by GoodRx and reviewed and distributed by Stacker.
Miami Herald
19-05-2025
- Health
- Miami Herald
Nearly a third of Americans aren't filling their prescriptions because of high costs
Healthcare professionals write millions of prescriptions every year to help Americans manage symptoms and treat a range of conditions. But affordability, access issues, and drug shortages prevent people from actually filling these prescriptions. GoodRx Research ran a 12-month survey to better understand the dynamics that shape prescription medication fills and consumer behavior. The following insights come from this survey of nearly 12,000 Americans. The findings highlight the significant financial and accessibility challenges people with and without insurance face in filling their prescriptions. Key takeaways: According to a GoodRx Research survey, 29% of Americans leave prescriptions for medications unfilled due to cost. Cost is a barrier for people with and without insurance. Yet most patients don't talk about medication affordability with their shortages prevent 26% of Americans from accessing their prescribed medications. This includes access to essential medications like Ozempic, insulins, and some prescriptions present serious health risks and long-term healthcare expenses. According to the GoodRx survey, 33% of Americans (52 million if extrapolated to the general population) had a prescription sent to the pharmacy that was ultimately not filled. So why aren't people filling these prescriptions? Medication cost is the main reason. People also forget to pick up their medications. Timing is another big issue. When people do go to the pharmacy, their medication may be out of stock. And many people just can't get to the pharmacy in time. This finding is alarming given that nonadherence, or not taking a medication as prescribed, can worsen chronic conditions. The high cost of medications can force people to make difficult choices between prioritizing their health and managing other essential expenses. In turn, this can lead to poor health outcomes and increased costs in the long run. Medication cost is the leading cause of unfilled prescriptions in the U.S. And this is an issue that affects people with and without health insurance. In fact, nearly a quarter of Americans are unable to fill their medication because their insurance doesn't cover it. When insurance doesn't cover a medication, patients are often on the hook for the full price. They may face financial strain and, ultimately, gaps in treatment and worsening symptoms. As it turns out, individuals who rely on the Affordable Care Act health exchange insurance plans have poorer coverage compared to other plan types. Among those on health exchange plans, 34% report a lack of prescription coverage. People with Tricare, Veterans Affairs (VA) insurance, or other military insurance have the highest rates of prescription coverage. GoodRx Research found that 23% of people spent more than $50 on their prescriptions per month (after removing respondents with Medicaid coverage). And nearly 10% reported spending over $100 on their prescriptions in the most recent month. And, once again, people with a health exchange plan, no insurance, or private insurance seem to pay more out of pocket on their prescriptions each month. Costs vary a lot for people with exchange plans. Only 19.7% pay nothing out of pocket and 2.9% pay $200 or more per month. This group, along with those enrolled in private insurance, appear to have the worst coverage for prescription medications. A substantial portion of their out-of-pocket costs falls into the mid-to-high cost brackets. Medicaid recipients, on the other hand, appear to have the most comprehensive prescription coverage. This finding is a reminder that prescription affordability will remain a barrier to medication adherence concern for many Americans until costs come down or insurance coverage improves. Research shows that patients want to talk about cost with their physicians, but few are actually doing so. The GoodRx survey of American adults found that only 42% were having these conversations. And given that cost is a barrier to filling prescriptions, cost conversations should happen every time medications are prescribed. While some Americans can't afford their medications, 26% can't access their medication at all due to shortages. Among the drugs that people are struggling to access are Ozempic, Trulicity, Zepbound, Mounjaro, Losartan, Adderall, and some antibiotics. Factors contributing to shortages may include increased demand, supply chain issues, and manufacturing delays. Methodology The survey was run through YouGov, in three waves. The survey ran monthly from February 2024 through January 2025. In each wave, GoodRx collected 1,000 responses. Survey responses were weighted to the U.S. population using age, gender, race, political affiliation, and education level. The YouGov survey research arm provides more information. To estimate the number of Americans who left a prescription at the pharmacy each month, the survey's incidence rate was multiplied by the percentage of respondents who reported leaving at least one prescription at the pharmacy. This product was then multiplied by the total number of American adults, based on data from the 2019 American Community Survey. This story was produced by GoodRx and reviewed and distributed by Stacker. © Stacker Media, LLC.
