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

Posted: Updated:
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.


  • Social Connect

  • Contact

    AZ Family