Anyone else have TRICARE insurance

[anonymous]

I am looking for anyone else out there who has tricare insurance. I am the Sponsor and my husband is the dependet with CF. We are trying to get tricare to cover Boost/Ensure plus shakes to supplement his meals and they have denied our claim and our appeal. I am not stopping there though. I am wondering if there are any other CFers on this site with tricare insurance that have had luck having tricare pay for the shakes, and what you did to make it happen.

Thanks
Julie

 

[Liza]

Hi Julie, We have Tri-Care Prime. My husband is AD/AF, we're stationed here at Offutt in NE. We have not tried getting them to cover boost or ensure. Neither of our girls will touch the stuff. My husband is a provider, ENT PA, out here at EB Hosp. We've had a run of bad luck these last two days and he's in the hospital right now with a broken arm awaiting surgery but will ask him if he knows of how you might get around TriCare and getting them to cover it. My ?, have you tried getting the hospital pharmacy where you are stationed to supply it? It's a thought if you haven't tried. Our hospital pharmacy gets our Pancrease MT16 & Pulmozyme through High Dollar( it comes from Wright Patt). My oldest is alternating Coly and Gent and we just get that at the Target Pharmacy and pay our $3 for each months supply. We tried the mail order pharmacy when we were stationed in Germany and to be honest they were a pain then substituted generic for the Pancrease (before the big NO, NO was announced) We stopped and ended up switching to an enzyme we could just pick up at the Dutch Pharmacy. Anyhow... Everything else they take is on the formulary so there was nothing special we needed to do. I'll ask him and see if he's got any ideas. Where are you stationed?

Liza
(mom of 2 teen girls w/CF)

 

[anonymous]

We did try to get the boost through the military treatment pharmacy but they don't carry it on their formulary. They only carry it for inpatients. We did get a RX from our physician and tried to fill it at a Wal-mart pharmacy but tricare denied it saying it was not a covered benefit. so I appealed their denial with a letter from my physician and they denied it again. My husband is 6f 185lbs, and I keep trying to explain to them that we (myself, him and his docs) feel the only reason he has been this healthy thusfar is because he has been able to maintain his weight and therefore avoid the common infections that befall Cfers. His boost shakes were previously paid for by medicaid in Washington state. It is extremely difficult to get a state program to pay for something like that so I never thought Tricare would get their panties in a wad over it (excuse the expression). I am going to appeal again and request a fair hearing, but I believe that is our last option. If you know or hear anything I would welcome it.

Thank you,

Julie

 

[Liza]

Hi, Talked to my husband today and he said he's never seen Tricare cover a supplement before. I remember when they didn't want to cover ADEKs because it was a vitamin. They said we could get it over the counter. We ended up getting hte base pharmacy to order it. It's not a quick thing because they only do a review for stuff like that once a quarter or something. He did suggest giving the pharmacy a try though. Depending on how much he uses, maybe it is something they could order just for your husband. That request though would need to come from you primary care provider, Military not civilian, I'm sure. It's a thought. I'm sorry I couldn't be of more help. Have you looked into the CF foundation pharmacy? They have really good prices on their meds and supplements.

Liza

 

[anonymous]

on the Cf foundation website they talk about the scandi products, they are free if you use their enzymes which my husband does. But the product is honestly a joke. so much sugar and fat and not much of anything else important. My hubbie prefers the boost or ensure because they have lots of protein and lots of calories. We did try the pharmacy and I met a brick wall. Our military physician was even the one to order it. I swear sometimes the military doesn't think things through. When he starts loosing weight and gets sick, I am really going to rub this one in their face!

Thanks for your help,
Julie