URBANA — A desire to quit smoking for good drove Urbana resident Terry Levesque to seek prescription help to kick his addiction.
But an odd prescription insurance coverage glitch between Medicare and TRICARE – or the coverage provided to veterans – put the cost of the needed smoking cessation drug out of reach.
TRICARE is a health insurance program that serves as the primary health insurance coverage for many active duty, National Guard and Reserve, veterans and some military families.
Levesque, 66, had quit smoking about five years ago, but recent family stresses – the loss of loved ones, for example – pushed him toward smoking again. Levesque, who served in the U.S. Army from 1968 to 1988 as a computer programmer, had been a smoker for 25 to 30 years when he decided he wanted to kick the habit.
“Just trying to do it on my own, it wasn’t working,” he said. “I just wanted to stop smoking. With me it’s more a habit and addiction than any means of pleasure. I don’t like smoking, don’t like the smell.”
Levesque also tried other smoking cessation regimens that would wean the smoker off nicotine over time, but they also did not work for him.
Levesque’s father also smoked, so it was always in the house, making it almost natural for him to start. But he didn’t start smoking until he went into the military.
His doctor suggested the drug Chantix, which blocks the receptors in the brain that affect smoking cravings. The drug is usually prescribed for three to four months. Levesque said the $200 per month drug would not fit in his budget; and TRICARE would not cover the cost of the drug.
Once TRICARE beneficiaries age into Medicare coverage, Medicare becomes the primary source of insurance and TRICARE fills any gaps in coverage. Since TRICARE has a prescription drug service, Medicare-eligible TRICARE beneficiaries are often discouraged from signing up for Medicare Part D prescription plans, according to a press release from the office of U.S. Sen. Sherrod Brown, D-Ohio.
Levesque said while he could have signed up for Medicare Part D, the copays for TRICARE prescription coverage are more affordable.
Both Medicare and TRICARE cover smoking cessation counseling, and Medicare covers the prescription cost for smoking cessation medication, but TRICARE does not.
Miffed by this incompatibility, Levesque contacted Brown and explained the discrepancy. Brown’s office worked to insert a provision into the Fiscal Year 2016 National Defense Authorization Act (NDAA), which makes a technical change to ensure that Medicare-eligible TRICARE beneficiaries are reimbursed for FDA-approved smoking cessation prescriptions to complement counseling and other smoking cessation efforts.
It took over a year, but the U.S. Senate just passed the NDAA, which now heads to President Barack Obama’s desk for a signature, according to a press release from Brown’s office.
“We should be making it easier for our nation’s veterans to quit smoking – not placing additional barriers in their way. Every person who wants to quit smoking should have full access to the resources needed to do so – especially those who have served our country,” Brown said in a press release. “The current gap in coverage has made it difficult for Medicare-eligible TRICARE beneficiaries to access the tools they need to help them quit. This bill will help ensure that TRICARE for Life insurance is fully serving the needs of our service members, our veterans and their families.”
Levesque knows he’s not the only veteran who has wanted to quit smoking and ran into the same problem. He’s hoping, if Obama signs the bill, that everyone will be able to benefit.
“I hope that a lot of the other guys take advantage of it,” he said. “I’m looking forward (to starting Chantix). I’d like to walk away from (smoking), maybe be done by Christmas.”
Casey S. Elliott may be reached at 937-652-1331 ext. 1772 or on Twitter @UDCElliott.