Chiaramente, ogni formato ha i propri vantaggi e svantaggi comprare amoxil senza ricetta per effettuare un acquisto, non è necessario fornire la prescrizione medica.
Volume 20 • Number 2
March - April 2006
Report from the Hill
Submits 2007 As we reported in our last nel. As a result, patients were forced to
Advocate, the Department of use the more expensive private sector
Defense has proposed signifi- medical providers. One part of the
cant increases in TRICARE fees and analysis that is missing in this entire
has imposed premiums for TRICARE discussion is a determination of the
Standard for the first time in history. You proper proportion of contract-care to
can see from the accompanying chart direct-care in MTFs.
erans Affairs R.
that the premiums and copays represent
The problem with increasing care in
major out of pocket expenses to retirees. the private sector is that it increases the
Also, for the first time in the history military medical budget. The cuts were
of the TRICARE Standard program made despite the fact that study after
will seek a record
or its predecessor -- CHAMPUS, study over a period of years showed
$80.6 billion in
up-front premiums would be im- that medical care can be delivered in
posed on the Standard program. This MTFs at much less cost than buying
2007 budget for the Department of
proposal has been sent to Congress the care from the private sector. Some
Veterans Affairs (VA), with the over-
where it will be considered by the studies showed that the savings were
whelming majority of these resources
Armed Services Committees in both more than 30 per cent.
targeted for health care and disability
houses and if passed, would be effec-
Another problem with disman-
compensation. The FY ‘07 proposal
tive on 1 October 2006 (see chart on tling the direct care part of the Mili-
represents an increase of $8.8 billion,
tary Health System is that by reducing
or 12.2 percent, above the budget for
The White House Office of the number of major teaching hospi-
Management and Budget (OMB) is tals and reducing the size and variety of
"Veterans are a priority. That's why
driving this issue by forcing budget Graduate Medical Education programs,
the President is proposing this historic
cuts on the military health system. It the programs that attract and keep top
budget with a landmark increase to
is truly outrageous to reduce benefits quality young doctors, nurses and other
continue the best health care and vital
during wartime when other options are medical professionals in the military
benefits to those veterans who count on
available and in this case, DoD poli- services are thereby also reduced. In
VA the most," Nicholson said. "With
cies of the past have helped create the addition, the shortage of medical
the support of Congress, we can
budget problem in the first place.
professionals has serious implications
take care of the needs of our newest
When the cold war ended, it made in time of war. For example, I spoke
generation of combat veterans, while
sense to deactivate combat units and recently with the commander of a major
honoring our commitment to veterans
air and naval forces as well as the forces hospital who stated that because of the
of earlier eras."
supporting them. Medical forces were small number of physicians in certain
The FY '07 budget proposal calls
reduced as well. However, the need for specialties, their frequent deployments
for $38.5 billion in discretionary
medical support did not drop as dramat- are causing many of them to leave the
funding -- mostly for health care. This
ically as the need for heavy armor, service. And of course, the fewer the
budget contains the largest increase
mechanised infantry, fighters, bombers, doctors the worse the problem. Over
in discretionary funding for VA ever
naval forces and other combat forces. time, this will have a negative impact
requested by a President. For health
In addition, Base Realignment and on the quality of doctors serving.
care alone, the President's request is
Closure Commissions were employed
With constraints on the budget and
an increase of $3.5 billion (or more
to recommend closure of hundreds of end strength, military service chiefs
than 11 percent) over the FY '06
bases including the closures of Military are faced with making tough choices
level. The budget proposal also would
Treatment Facilities (MTFs) and between the need for warfighters and further reductions in medical person-
continued on page 3
continued on page 6
Instead of my usual column this issue, I want to share Many forget that it is because of great sacrifice, that
something that is very personal to me. Recently my
has occurred many times in our nation's history, which
grandson wrote an outstanding essay for his high
allows us to live without tyranny and oppression taking
school history class. The VFW sponsored a scholarship
over our every day lives. We need not live in fear of a
competition for the best essay and this is his entry into the
secret police force breaking into our homes and arresting
competition. Needless to say, I am very proud of him and I
us in the middle of the night. We need not live in fear of
hope you enjoy what he wrote as much as I do.
mass genocide taking place due to one's ethnic or religious backgrounds. We need not live in fear of a corrupt and
Celebrating our Veterans' tyrannical government taking power and ruling every
aspect of our daily lives. These are the things our Veterans
fought and died to prevent, and I am proud to say that I live in a land where so few would be willing to dedicate their
An Essay by Chris Russell
lives to the welfare and freedom of so many.
I attended the WWII Memorial dedication on Memorial
When one thinks of how to celebrate our Veterans'
Day in Washington, D.C., and it was definitely one of the
service and sacrifice, one almost instinctively turns to the
most fulfilling experiences I have ever had the opportunity
several monuments we have erected to honor such people.
to be present at. It was made even more so because I
The Vietnam Memorial, the Korean Memorial, the WWII
attended it with my grandfather, who served both in WWII
Memorial and the statue of the Marines raising the flag
and in Vietnam, retiring as a Command Sergeant Major.
on Iwo Jima all make us think of what these valiant souls
I felt it extremely important that something be left
accomplished and sacrificed for their country and for each
behind to remember him and all who fought in the defining
war of the twentieth century, so that future generations may
We also have several holidays that recognize the very
not forget what great sacrifice those men and women went
same thing as the monuments, most notably Memorial Day
through to preserve our freedoms and liberties.
and Veterans' Day. When we visit these Memorials, and on
While I was there, though, I realized that a Monument
these holidays, we reflect on how our Veterans' service to
was not needed to remind us of that. Every time we speak
our country has impacted our lives and how it has made our
out for something we believe in we are reminded of our
rights. Every time we vote for our town mayors, our state
When one views these moving Memorials, images may
representatives and senators, and the President of the
be conjured up in one's mind of war, death, struggle and
United States we are reminded of our democracy.
sacrifice. It is here that people are again reminded, although
Every time we wake up in the morning and have the
they will soon forget, that many Veterans died over the
ability to pursue what we want to do with our lives, we are
history of our nation so that we may live as we do today.
reminded of our freedom. All these things would not have
What about all the other days of the year however? Why
been possible, however, without the service and sacrifice
do we celebrate our Veterans' service only a couple times
of our Veterans, and because of that I say thank you, for
a year, and even then why is it only viewed by many as a
making it possible for me to live a better life.
long weekend? This is because Americans have enjoyed
One must always remember that freedom is most
such instrumental and natural rights as freedom of speech,
certainly not free.
religion, press, assembly and the ability to live in a free and democratic nation ever since America's birth that we take
Chris Russell is a sixteen year old high school student in
them for granted.
We do not fully realize the importance of these
liberties, and therefore do not properly pay homage to those who made them possible. These freedoms have been paid for in blood ever since America was a country, in the Revolutionary War, and all the way up to today in Iraq.
DoD to Restrict Cell Phone
VA Warns of
Use on Military Bases
Defense Department installations violation of the rules,
have begun implementing he said. new cell phone restrictions for
As the installations implement the
drivers on military bases. The new restrictions, they have a responsibility
The VA is warning veterans not
to give credit card numbers
regulation states that anyone driving to notify the public by putting up signs
over the phone to callers
a motor vehicle on a DoD installation or putting notices in base newspapers,
claiming to update VA prescription
cannot use a cell phone unless the Seibert said. Many installations are
information. The VA does not call
vehicle is safely parked or the driver is allowing a grace period in which
veterans and ask them to provide
using a hands-free device.
motorists in violation of the rule will be
personal financial information.
Many installations already have warned and not ticketed.
The latest scam involves callers
implemented the new restrictions,
This regulation was developed
who say they're working for the
and the rest will implement the rules based on information from the National
"Patient Care Group." They claim
on their own schedule, said John Highway Traffic Safety Administration,
that VA recently changed procedures
Seibert, assistant for safety, health and which studied driving distractions as
for dispensing prescriptions and ask
fire protection for DoD. There is no the cause of motor vehicle accidents,
for the veteran's credit card number.
deadline for installations to implement Seibert said. The study found that cell
This is not true.
the restrictions, Seibert said, but he phone use is the fastest growing and
Veterans with questions about
expects most will do so this year. "We most visible distraction that leads to
VA services should contact the
have not issued an implementation accidents, he said.
nearest VA medical center or call
schedule," he said. "But it's definitely
The DoD regulation follows suit
getting everyone's attention."
with many regulations that states and
The law enforcement policy offices cities have already imposed. Currently
for each military department are putting only Connecticut, New York, New Jersey
together policies and procedures for and the District of Columbia ban hand-the implementation and enforcement held cell phones for drivers, but many of the restrictions, Seibert said. He cities have imposed their own rules, explained that this regulation is a according to the Governors Highway
minimum requirement, and installation Safety Association. "We are in front of commanders still have the authority to put the majority, but we certainly are not the stricter rules in place. Each installation first ones to do this," Seibert said. ❧will determine the punishment for
While AMS is generally pleased with the funding
request, we are troubled that the budget includes a proposal to charge an annual enrollment fee of $250 for veterans in
2007 VA Budget
Priority levels 7 and 8, who are enrolled in the VA system.
continued from page 1
It also increases pharmacy co-pays from $8 to $15 for those same veterans. In addition, it proposes that veterans
provide $42.1 billion in mandatory funding, mostly for receiving treatment for nonservice-connected disabilities
compensation, pension and other benefit programs.
be billed for the entire co-pay. This is the same proposal
The budget request comes on top of a year of that AMS helped defeat in Congress last year, and we will
embarrassments for the Department of Veterans Affairs in fight to kill it once again this year. While Priority level 7
2005 when Secretary Nicholson had to go to Congress and and 8 veterans do not have service-connected disabilities,
ask for emergency funds after the Department admitted that they were invited by the VA to enroll in the VA health care
the funding it had requested would fall far short of meeting system in 1996. Former VA Secretary Principi subsequently
the needs of the nation's veterans. In addition, just a few days closed the door to further nonservice-connected veterans.
before the new budget request was released, the Associated However, we believe that those who did enroll should be
Press reported that the Government Accountability Office taken care of. There should be full funding for all enrolled
had issued a report stating that the VA had used "misleading veterans, and these enrollment fees and increased co-pays
accounting methods and lacked documentation to prove its should not be imposed upon them. ❧ ❧
3 drug types added to formulary; 16 taken off
Three classes of medications used to treat benign Formulary drugs
prostatic hypertrophy (enlarged prostate) and Alpha Blockers for Benign Prostatic Hypertrophy:
cardiovascular disease have been added to the Doxazosin (Cardura®), terazosin (Hytrin®), and alfuzosin
TRICARE Uniform Formulary and 16 medications in those (Uroxatral®)
classes are being moved to non-formulary status. The drugs ACe inhibitors:
are listed below.
Benazepril (Lotensin®), benazepril/hydrochlorothiazide
The TRICARE Uniform Formulary (UF) is a list (Lotensin HCT®), captopril (Capoten®), captopril/
of medications approved by DoD for distribution in the hydrochlorothiazide (Capozide®), enalapril (Vasotec®),
Military Health System. Drugs are grouped into three enalapril/hydrochlorothiazide (Vasoretic®), fosinopril
tiers: formulary generic (tier one), formulary brand name (Monopril®), fosinopril/hydrochlorothiazide (Monopril-
(tier two) and non formulary (tier three). Beneficiaries' HCT®), lisinopril (Prinivil®, Zestril®), lisinopril/
copayments are based on a medication's grouping within hydrochlorothiazide (Prinzide®, Zestoretic®), and
Beneficiaries will pay $22 for up to a 30 day TRICARE Calcium Channel Blockers:
Retail Network Pharmacy (TRRx) or 90-day TRICARE Diltiazem immediate release (Cardizem®), diltiazem
Mail Order Pharmacy (TMOP) supply for non-formulary sustained release (cardizem SR®), diltiazem extended
medications. Beneficiaries will pay the higher of $22 or release (Cardizem CD®, Dilacor XR®, Cardizem CD®,
20% in retail non-network pharmacies.
Cartiz XT®, Tiazac®, Taztia XT®), felodipine (Plendil®),
Patients currently using the medications which are being nifedifine immediate release (Procardia®), nifedipine
designated non-formulary may wish to ask their doctors extended release (Adalat CC®, Procardia XL®), nimodipine
if switching to formulary alternatives or documenting (Nimotop®), nisoldipine (Sular®), verapamil sustained
a medical necessity would be appropriate for them. If release (Isoptin SR®), and verapamil immediate release
medical necessity for using non-formulary medications is (Isoptin®, Calan®, Calan SR®)
established, patients may qualify for the $9 copayment for
up to a 30-day TRRx supply or up to a 90-day TMOP supply. Non-Formulary drugs
Military treatment facilities (MTF) will no longer carry Alpha Blockers for Benign Prostatic Hypertrophy:
these or other non-formulary medications on their local Tamsulosin (Flomax®) Implementation date: February 15
formularies. Non-formulary medications may be available ACe inhibitors:
at MTFs only when medical necessity is established and Quinapril (Accupril®), perindopril (Aceon®), ramipril
the prescription is written by an MTF provider. Medical (Altace®), and moexipril (Univasc®) Implementation date:
necessity forms are available at http://www.tricare.osd. February 15
mil/pharmacy/medical-nonformulary.cfm. Procedures for Calcium Channel Blockers:
completing and submitting medical necessity information Amlodipine (Norvasc®), isradipine (DynaCirc® and
may be found on these forms.
DynaCircCR®), nicardipine (Cardene® and Cardene SR®),
Eligible beneficiaries may fill prescriptions for non- verapamil extended release (Verelan®), verapamil extended
formulary and covered medications through the TMOP and release for bedtime dosing (Verelan PM®), and Covera TRRx pharmacies. Beneficiaries may reduce out-of-pocket HS®, and diltizem extended release for bedtime dosing expenses by filling prescriptions through the TMOP where (Cardizem LA®) Implementation date: March 15 ❧they may receive up to a 90-day supply of medicine for the same cost as a 30-day supply in the TRRx. For more information about TMOP, go to http://www.tricare.osd.mil/pharmacy/tmop_contact.cfm or call 1-866-DOD-TMOP, (1-866-363-8667). Beneficiaries may also contact the TRRx customer service line at 1-866-DOD-TRRX, (1-866-363-8779), or visit http://www.tricare.osd.mil/pharmacy/trrx_contact.cfm.
For more information about medications, beneficiaries
can go to http://www.tricareformularysearch.org/dod/medicationcenter/default.aspx.
CRSC – How to document your disability
Have you applied for Combat- records that document the injury? If free 1-866-272-6272 and press "4" to
Related Special Compensation so, submit these documents and the be transferred .
(CRSC)? Or did you start to complete VA findings, decisions,
apply and stop because it was too reasons and basis with your CRSC Agency (NARA), located in 18 states,
difficult to document your combat- claim.
Recreating lost medical records is a my application?
daunting task. Make the process easier
The following groups are helpful:
Call 1-800-827-1000 or go to:
by using this guidance to document your
• County VA offices
injuries when you apply for CRSC.
• Major Veteran or Military address.htm or http://www.visn1.med.
CRSC is monthly, tax-free
compensation for certain military
• VA hospital counselors
retirees that supplements their VA
• The Army CRSC office in hospital after 1970 for my disability.
disability pay and retired pay. To apply
for CRSC, applicants must meet all the I lost my medical records. How do I
following criteria and have at least one recreate them?
VA-rated, combat-related disability:
There are several resources:
• Served at least 20 years active
a) Contact a VA hospital or MTF
Patient Administration Systems &
duty or be a Reservist age 60 or and provide them the following records, Biostatistics Activity (PASBA), ATTN: older with 20 or more qualifying if available:
Ms. Terri Amrhein, Analysis Branch,
1. Your current medical information 1216 Stanley Rd, Ste 25, Ft Sam
• Are in retired status;
documenting the injury.
Houston, TX 78234; (210) 295-8938.
• Are entitled to retired pay
2. Your personnel records proof such Only verifies hospital stays in an Army
that is offset by VA disability as: unit assigned, date assigned, location hospital after January 1971 and is to be payments; and
injured (e.g., 21st Tank Maintenance used only after requesting records from
• Have at least a 10% VA disability BN, Jun 1967-Sep 1968, RVN).
the National Personnel Records Center
3. Your signed statement, claiming or the VA if those sources to not have
Combat-related disabilities are how the injury occurred.
the medical records.
those incurred, with documented
4. A signed buddy statement, saying Once I have documented my combat-
how the injury occurred.
• In the performance of duty under
b) Ask a doctor, physician's steps?
conditions simulating war (e.g., assistant, nurse, or an officer for a copy
Obtain a CRSC claim form or
exercises, field training);
of your written medical consultation get questions answered by going to
• While engaged in hazardous visit on signed letterhead that states http://www.crsc.army.mil or by calling
service (e.g., flight, diving, "how" you got each injury.
1-866-281-3254. Complete your
claim and send it with the appropriate
• Through an instrumentality documents?
documentation to the address on the
of war (e.g., combat vehicles,
Center form. Make sure to include all of your
weapons, Agent Orange); or
for Research of Unit Records DD 214s with the application. ❧
• As a direct result of armed (USAFCRUR), 7779 Ciena Rd.,
Springfield, VA 22150; (703) 428-6801.
To approve your claim, the CRSC NOTE: Can still get Purple Heart
Office must know how your injury awards via records from USAFCRUR.
happened. You need to document Verifies combat activity from WWII
your combat-related disability. How? forward by Morning Reports.
The CRSC Office has supplied the Where can I get my personnel
Center (NPRC-MPR), 9700 Page Ave.,
Do you have VA records that St. Louis, MO 63132-5100; http://
document your combat-related disability www.archives.gov/st-louis/military-or military treatment facility (MTF) personnel; (314) 801-0800 or call toll-
Report from the Hill
continued from page 1
dod Proposed increase in triCAre enrollment
the need for medics. They often solve the
Fees, Co-pays and deductibles for under age-65
problem by converting military medical spaces to warfighters and then opting
retirees and Prescription drug Co-pay increases for
to use contract medical services, which
generally results in higher costs. A better solution would be to exempt a certain number of military medical spaces from
Summary of Proposed Changes to TRICARE Benefit
end-strength ceilings so that the service
Enrol ment Fee and Deductible Changes *
chiefs are not faced with this choice.
Two Year Phase-In (FY07-08)
A white paper completed several years
ago indicated that approximately 40% of
TRICARE Prime Annual
medical spaces could be removed from
Annual Enrol ment
the end strength ceilings and accounted for in a separate medical personnel
Retireed Junior Enlisted (E-6 and Below)
account. This would allow the Assistant
Secretary of Defense (Health Affairs)
and the service Surgeons General to
make decisions as to the proper mix of
uniformed personnel, civilian employees and contract support needed to accom-
plish the medical mission within the
Retired Senior Enlisted (E-7 and Above)
budget allocation without arbitrary end
strength limitations. The Joint Staff is
currently considering the formation of a
medical command which would facili-tate adopting this proposal. While we
realize this explanation tends to involve
a lot of minutia, the main thing to
remember is that there is a viable alter-native to what is now being done, and it
is an alternative that would be good for
retirees, good for the military, and good
for the taxpayer.
While we believe this proposal
may be a viable long term solution, the problem right now is the current effort to
* Applies ONLY to eligible retirees under age 65; no changes to active duty, active duty
shift medical costs to military retirees.
family members, or TFL
AMS, the National Military and Veterans
Changes in Pharmacy Co-payments *, **
Alliance and The Military Coalition are
fighting this attempt to push these costs onto the backs of retirees, their families
and survivors. Congressional hearings on
the Defense budget have already begun.
We ask you to contact both of your sena-
tors and your representative and let them know you oppose this effort. The only
Co-pays in FY07 and after
way we are going to beat this is with
overwhelming opposition from military
retirees and their families.
Chuck PartridgeGovernment Relations
* 100% co-pay for a few certain medications ** Applies to ALL eligible beneficiaries, except active duty
American Military society Membership Application Form
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Yes, I want to join in support of a strong national defense and take advantage of the great benefits AMS offers. I
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Permit No. 495
Las ineficiencias del sistema Revista quincenal de gestión sanitaria 20 de junio de 2013 Nº 22 en sanidad: 2.000 El sistema sanitario sigue derrochando al duplicar la mitad de las pruebas o realizar otras ineficaces Análisis P3 ‘elEconomista Sanidad' cumple un año desde su nacimiento Aniversario P16 Termina la patente más deseada:
Headache can be classified into two broad categories: primary and secondary. Primary headaches include cluster and tension headaches. Secondary headaches are triggered by an underlying disorder – such as infection, injury or a Headaches can have more than one contributing factor the muscles and skin of the head, neck and shoulders