Veteran: TRICARE putting my health at risk for $6.96 a month

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Dale Cillian says he needs his name-brand medication but TRICARE won't cover it. (Source: 3TV/CBS 5) Dale Cillian says he needs his name-brand medication but TRICARE won't cover it. (Source: 3TV/CBS 5)
Under Department of Defense policy, TRICARE will fill prescriptions with generic equivalents whenever generics are available. (Source: 3TV/CBS 5) Under Department of Defense policy, TRICARE will fill prescriptions with generic equivalents whenever generics are available. (Source: 3TV/CBS 5)
My insurer saves $83.64 annually by prescribing me a medication that makes me sick enough to visit the emergency room, Cillian said. (Source: 3TV/CBS 5) My insurer saves $83.64 annually by prescribing me a medication that makes me sick enough to visit the emergency room, Cillian said. (Source: 3TV/CBS 5)
PHOENIX (3TV/CBS 5) -

A Valley veteran says his military health insurance is putting his health at risk – all to save a few dollars a month.

Retired Army reservist Dale Cillian is locked in a battle with TRICARE as his prescription medication runs out. He is now down to his last pill.

Cillian has been taking brand-name Protonix for 15 years to treat a severe form of acid reflux disease called gastroesophageal reflux. But after getting TRICARE about a year and a half ago, the health insurance program for service members now wants to switch him to a generic drug.

The problem, Cillian says, is that he tried generic versions of Protonix four times before. Each time, he had severe side effects.

“It's severe digestive issues,” he said. “I mean, you feel like it's the end. It's pretty painful.”

In the most severe case, Cillian said he became ill for 10 days and had difficulty getting out of bed.

Cillian and his doctor have repeatedly requested authorization from TRICARE to cover brand-name Protonix. Cillian even sought help from Sen. John McCain's office. Their second appeal was denied in a letter dated March 9.

Under Department of Defense policy, TRICARE will fill prescriptions with generic equivalents whenever generics are available, according to a letter from the program’s pharmacy benefits provider, Express Scripts, Inc.

To get coverage for a brand name drug, physicians must demonstrate that the brand name is medically necessary. In Cillian’s case, “the information provided by your physician did not meet TRICARE criteria to allow approval,” according to the letter.

Cillian said his doctor has done all he can.

“My doctor has sent them numerous letters telling them I can't do it. I’ll have a reaction,” he said. “It's not working.”

What irks Cillian the most is the price. Protonix costs his insurer $335.45 for a 90-day supply. The generic saves the insurance company just $6.96 a month.

“My insurer saves $83.64 annually by prescribing me a medication that makes me sick enough to visit the emergency room,” Cillian said.

When contacted for comment, a spokesman for Express Scripts said he would look into the matter.

Cillian said he is perfectly willing to more than cover the difference in price through a co-payment of $10 or $20 a month, but he says TRICARE won’t consider it.

“That’s not even an option," he said. “TRICARE is black and white. There is no gray area.”

Are you a veteran or active duty service member having trouble with your military health care or benefits? Send Derek an email

Copyright 2017 KPHO/KTVK (KPHO Broadcasting Corporation). All rights reserved.


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Derek StaahlDerek Staahl is an Emmy Award-winning reporter and fill-in anchor who loves covering stories that matter most to Arizona families.

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Derek Staahl

This once-uncompromising "California guy" got his first taste of Arizona in 2015 while covering spring training baseball for his former station. The trip spanned just three days, but Derek quickly decided Phoenix should be his next address. He joined CBS 5 and 3TV four months later, in August 2015. Before packing his bags for the Valley of the Sun, Derek spent nearly four years at XETV in San Diego, where he was promoted to Weekend Anchor and Investigative Reporter. Derek chaired the Saturday and Sunday 10 p.m. newscasts, which regularly earned the station's highest ratings for a news program each week. Derek’s investigative reporting efforts into the Mayor Bob Filner scandal in 2013 sparked a "governance crisis" for the city of San Diego and was profiled by the region’s top newspaper. Derek broke into the news business at WKOW-TV in Madison, WI. He wrote, shot, edited, and presented stories during the week, and produced newscasts on the weekends. By the end of his stint, he was promoted to part-time anchor on WKOW’s sister station, WMSN. Derek was born in Los Angeles and was named the “Undergraduate Broadcast Journalism Student of the Year” in his graduating class at USC. He also played quads in the school’s famous drumline. When not reporting the news, Derek enjoys playing drumset, sand volleyball, and baseball.

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