After three years, Walmart is leaving Tricare's pharmacy network -- a departure that pharmacy benefit manager Express Scripts says is a result of the retail giant's reluctance to offer "more highly competitive discounts" to military health beneficiaries.

At the same time CVS Pharmacy will return to the Tricare network after a five-year hiatus, a change Express Scripts spokeswoman Jennifer Luddy said Wednesday would expand choice within the network.

Effective Dec. 15, 2021, Walmart and Sam's Club will no longer be a part of the Tricare pharmacy network, and CVS will be included among the list of network retail pharmacies where Tricare users can fill their prescriptions.

"This change provides more competitive rates for the Tricare pharmacy benefit and expands quality, convenient pharmacy choices nationwide," Luddy said in a statement to Military.com.

Walmart and Sam's Club have more than 5,300 locations nationwide, according to Walmart's website.

Walmart joined the Express Scripts network in 2018, signing a three-year contract to provide prescription services to the pharmacy benefit management company's clients, including Tricare and the Defense Health Agency.

The contract expires in December and Walmart and Sam’s Club will be removed from the network, Luddy said. Walmart did not return a request for comment by publication.

Meanwhile, CVS, a company that left the Tricare network in 2016, also after negotiations failed, will return to the network, giving beneficiaries access to its nearly 10,000 pharmacy locations, including inside many Target stores.

Under the agreement, as of Dec. 15, all prescriptions filled at a Walmart will be considered non-network. Beneficiaries will have to pay the full cost of their medication up front and file a claim with Tricare for partial reimbursement.

Having access to Walmart pharmacies has been especially convenient to military families who live in rural or remote areas that may lack a chain pharmacy. But Luddy said Walmart "declined several opportunities to offer more highly competitive discounts to continue to serve Tricare beneficiaries."

As a pharmacy benefit manager, Express Scripts serves as somewhat of a middleman, overseeing the Defense Health Agency's pharmacy program, determining the reimbursement rates to retail pharmacies that fill patient prescriptions, and billing the government in turn.

It also is responsible for transactions involving the government purchase of medicines for military installations and provides the Tricare mail-order pharmacy program.

In the past decade, the Defense Health Agency has increasingly encouraged -- and in some cases, required -- beneficiaries to fill their prescriptions at no cost at military pharmacies or use the mail-order system to fill long-term prescriptions at lower cost.

Pharmacy copays have risen substantially over the past 10 years, in large part due to cost but also as required by Congress as part of a cost-cutting measure to the defense medical budget.

In 2011, 30-day prescriptions of generic medications and brand-name drugs could be purchased at a network pharmacy for $3 and $9 copayments, respectively, while medications not in Tricare's formulary cost $22.

The mail-order system offered generic medications at no cost and brand-name formulary drugs for a $9 copayment for 90-day prescriptions.

This year, Tricare beneficiaries pay $11 for a 30-day supply for a generic drug and $33 for a brand-name medication at retail pharmacies. Non-formulary drugs not listed in Tricare's list of covered medications cost $60.

Copayments for the mail-order pharmacy run $10 for a generic prescription and $29 a brand-name drug for a 90-day script. And the rates are expected to rise next year.

Luddy said that Express Scripts will be reaching out to patients who take specialty medications to help them transfer their prescriptions without a gap in coverage.

According to Express Scripts, the Tricare pharmacy network covers 56,000 stores, including chains such as Walgreens and Rite Aid and supermarkets like Kroger and Publix.

Tricare provides coverage to 9.6 million beneficiaries worldwide.

2,000 New Processors Being Hired to Help With Looming Spike
Veterans Affairs leaders are bringing on more than 2,000 claims processors to deal with an
expected spike in overdue cases that could push the department’s claims backlog to its highest
level in seven years. Department officials are also planning to use mandatory overtime for
thousands of already-working claims staff and emergency coronavirus pandemic funding to help
stem the problem. Even with that, Veterans Benefits Administration officials expect it to take two
and a half years to bring the backlog back down to pre-pandemic levels. But they also are insisting
veterans waiting on their claims to be processed should not panic.
“We don’t want people to worry when they see that number,” said Mike Frueh, VA’s Principal
Deputy Under Secretary for Benefits. “We want veterans to keep filing their claims.” As of the
end of September, the claims backlog — the number of cases that have been pending for more
than four months — was at 208,000. That’s almost triple the typical monthly backlog total from
before the start of the coronavirus pandemic in early 2020. Officials said office closures caused
by the pandemic steadily drove up the backlog total for much of last year. The problem was further
exacerbated by several court decisions and new laws mandating additional benefits for troops
exposed to Agent Orange during the Vietnam War, which added to the total volume of cases being
added to the VA system.
That’s also why VA officials know another backlog spike is coming. About 70,000 claims
related to new benefits rules for Parkinsonism, bladder cancer and hypothyroidism linked to
poisoning from the chemical defoliant are due to hit the four-month mark at the end of October.
Frueh said officials estimate the backlog will reach more than 260,000 then. But Frueh said
officials are processing cases at a record rate, and do not expect the backlog to reach the same
challenges as in 2013, when an influx of new benefits swelled the total to more than 600,000.
Thousands of those cases lingered in the VA system for years without resolution.
Officials don’t expect the same difficulties this time, although Frueh acknowledged it will
likely take until early 2024 to fully return to pre-pandemic levels. “We are the front door to VA
benefits and services,” he said. “This is a natural consequence of people filing more claims.” The
department processed more than 1.5 million claims in fiscal 2021, the most ever. But they also
received about 1.7 million claims, and expect the number to rise even higher with the recent
benefits changes. The short-term hiring of 2,000 new claims workers — the largest such effort by
the department ever — will provide long-term relief to the claims processing problems. However,
it will take months before those staff are fully trained and able to handle standard workload
amounts.
Since May, the benefits administration required 20 hours of mandatory overtime a month to
deal with the backlog spikes. Those requirements will continue for the foreseeable future, Frueh
said. In a statement, VA Secretary Denis McDonough said the department remains “committed
to ensuring timely access to benefits and services for all veterans.” On the VA web site
https://www.benefits.va.gov/reports/deta...s_data.asp more information on the backlog
is available.

SSA has announced a 5.9% COLA increase in Social Security benefits effective
December 1, 2021. Therefore, applying the same percentage, the following increased
rates and income limitations for the DIC program became effective December 1, 2021
DIC Payable to a Surviving Spouse – Veteran death on or after January 1, 1993
Basic Monthly Rate: $1,437.66
If at the time of the Veteran's death, the Veteran was in receipt of or entitled to
receive compensation for a service-connected disability rated totally disabling
(including a rating based on individual unemployability) for a continuous period of
at least 8 years immediately preceding death and the surviving spouse was
married to the Veteran for those same 8 years, add: $305.28.
For each dependent child under the age of 18, add: $356.16.
If the surviving spouse is entitled to Aid and Attendance benefits, add $356.16.
If the surviving spouse is entitled to Housebound benefits, add $166.85.
If the surviving spouse has one or more children under the age of 18 on the
award per 38 U.S.C. 1311(f), add the 2-year transitional benefit of $306.00

For full release with even more information please check in our Download Resource area
under Benefits for UPDATED DIC payment pdf

42% of the 2,126 Post-9/11 Vets Having It Have Been Denied

While traumatic brain injuries and post-traumatic stress disorder have been called the "signature
wounds" of the Iraq and Afghanistan wars, affecting nearly half a million troops, thousands of
veterans also have been diagnosed with diseases possibly connected to environmental hazards
and toxic waste. Hundreds are fighting or have succumbed to glioblastoma, the most common
form of brain cancer, striking roughly 12,000 Americans each year. The few studies done on
military personnel and veterans to determine whether they have been getting glioblastoma at
higher rates than the general population have been inconclusive.
But glioblastoma is the third most common cause of cancer-related death in the active-duty
population, behind colon cancer and leukemia. And among post-9/11 veterans who deployed to
Iraq, Afghanistan and elsewhere, glioblastoma occurs at a rate 26% higher than that found in the
general population, according to calculations based on Department of Veterans Affairs and
National Institutes of Health data. Most of the stricken veterans and their families believe their
illnesses were caused by military environmental exposures. Yet 42% of the 2,126 post-9/11
veterans who have developed brain cancer have been denied access to health care and disability
compensation by the VA. The VA doesn’t single out glioblastoma, which accounts for about 80%
of all metastatic brain tumors, for claims purposes.
For veterans and family members dealing with the emotional and physical toll of battling brain
cancer, the added burden of quarreling with the VA over benefits can be too much. "We spent the
first year fighting the disease and the second year fighting VA," said Amy Antioho, widow of
former Army Capt. Peter Antioho, a West Point graduate who died of glioblastoma on Sept. 27,
2020. "It should not be this way." Antioho spends her days working on a farm and caring for the
couple's five-year-old son, Mark, who has come to know his father through notes from friends
and family recollections.
She tries to focus on the memories before cancer, but Peter's last days, spent in hospice, loom
large. She had to shelter him from nurses who kept telling him he would eventually get better and
go home. She remembers lying next to Peter, listening to the soundtrack of “Les Miserables,”
holding him just as Marius cradles a dying Eponine. She relives the moment she gave him
permission to go, trying to free him from the responsibility of caring for his family. She misses
her handsome soldier. "I just remember him saying the burn pit was going to kill him someday,"
Antioho said.
According to the NIH, the rate of glioblastoma in the general population, when accounting for
age, is roughly 3.2 cases per 100,000 people, with the median age of onset at 64. But according
to the VA, among post-9/11 veterans who deployed and have VA health care, the rate of brain
cancer – mostly glioblastomas -- averaged 5.2 cases per 100,000 per year from 2015 to 2019 in a
population in which nearly half are ages 30 to 39. The rates among Vietnam and Persian Gulf vets
are elevated as well – 6.2 per 100,000 per year between 2015 and 2019, according to the
department.
The VA automatically grants benefits to service members diagnosed with brain cancer on
active duty and to any veteran who worked with radiation while serving, or if they develop the
disease within a year of discharge. All others must file a disability compensation claim. Since
2002, more than 10,000 veterans with brain cancer or surviving family members of veterans from
the Vietnam, Persian Gulf and post-9/11 eras have had varying degrees of success. The VA told
Military.com and Public Health Watch on Nov. 5 that the claims approval rate was just 16.7% for
post-9/11 veterans with brain cancer, while it was over 70% and 80%, respectively, for Vietnam
and Persian Gulf War era veterans.
When reached for comment about this investigation days before publication, the VA revised
the data, indicating that the approval rate for post-9/11 veterans was much higher, 58%, but was
much lower, 31%, for Persian Gulf War-era vets. Officials said the 16.7% approval rate for post-
9/11 veterans was determined using a “dated system.” By utilizing a new algorithm that more
accurately sorted the veterans into their period of service the approval rates rose for post-9/11
veterans and dropped for Persian Gulf-era vets. “Because they used the wrong method, they were
missing some Gulf War veterans completely, and then hadn't appropriately segmented them into
Gulf War One and post 9/11,” explained Ken Smith, acting executive director of the Office of
Performance Analysis and Integrity at the Veterans Benefits Administration. “This is the correct
way of doing it.”
Regardless of classification, just about half of veterans who served since August 1990 and
developed brain cancer have had their claims denied. This, say veterans’ advocates, is
unacceptable. "People are dying, and to deny them the right to health care, to deny [compensation]
to their survivors who are spending their last minutes with their loved ones, it's criminal and
insulting," said Rosie Torres, co-founder of Burn Pits 360, a nonprofit in Robstown, Texas, that
supports veterans who believe they were sickened by environmental exposures. There is some
hope this year that the path could get easier. The VA announced in November that it is reviewing
whether some cancers and a rare lung disorder should be fast-tracked for disability benefits.
The department has not published a complete list of the cancers under consideration. But
veterans with glioblastoma and families of those who died from the disease believe it should be.
They note that the commander-in-chief's son, former Army National Guard Maj. Beau Biden,
died of glioblastoma in 2015. Biden had deployed to Iraq in 2008 and worked as a civilian near a
burn pit in Kosovo. "We know now you don't want to live underneath a smokestack where
carcinogens are coming out of it," President Joe Biden told Judy Woodruff on PBS NewsHour in
2018, comparing factory pollution to burn pits.

Note: Refer to https://www.military.com/daily-news/2022...efits.html to read more on this subject

Vets Must Now Verify School Enrollment Monthly or Lose It

Starting this month, all students receiving Post-9/11 GI Bill benefits must verify their school
enrollment each month or risk forfeiting their housing allowance. The change has been planned
for months and was already required for some students since last fall. But the new mandate also
has the potential to be a costly mistake for some individuals if they overlook the new monthly
messages from the Department of Veterans Affairs.
“If you fail to verify enrollment for two consecutive months, your [housing] payments will be
placed on hold,” department officials warned in a message explaining the verification
requirement. “By regularly verifying your enrollment, you protect your GI Bill entitlement by
preventing charges for classes or training you did not attend.” As many colleges begin their spring
semesters this month, some students could be seeing the verification messages for the first time
— or potentially ignoring them as unwanted spam. VA plans to send the messages out on the last
day of each month, and give students several days to respond before deactivating the links.
Department officials have been encouraging students to sign up for text message verification
or email alerts for months, in the hopes that no one would be caught off guard by the new
requirement. Late last month, as part of that campaign, VA officials also released a new video on
how to sign up for text message alerts at https://youtu.be/MKq-reD01ZA . The housing stipend
linked to Post-9/11 GI Bill benefits is designed to help students avoid the need for an after-school
job to pay for rent and groceries cost. Since payouts are based on the location of the student and
the school, the stipend can range from a few hundred dollars to more than $2,000 a month in the
most costly cities. Losing that money could have serious financial consequences for students and
their families.
About 360,000 students are attending classes on the Post-9/11 GI Bill this year. Of that total,
about half will be affected by the new verification changes. Students with additional questions on
the new verification requirements can visit the department’s website
https://benefits.va.gov/gibill/isaksonro...llment.asp for more information.

Veterans need to be well organized when it comes to keeping records for our significant others. They will
be stressed out enough dealing with our passing. They do not need the added chore of trying to find critical
items necessary for planning funerals and other issues. What follows is a list of documents that are
necessary to ensure that things get taken care of in a timely manner when we die.
The first item is a copy of your DD-214. This is the most important document relating to your military
service. It shows a funeral director that you are a veteran and, in some cases, determines the level of
services you are eligible for. If you are drawing benefits from the VA and you do not have a copy of your
DD-214, log on to www.ebenefits.va.gov where you will be able to find and print a copy, as well as review
your disability rating.
The second item is a copy of your award letter from the VA. This document shows what your
disabilities are and their percentages. If you are a 100 percent permanent and totally disabled veteran, the 
letter will save your significant other a lot of headaches when it comes to filing for Dependent Indemnity
Compensation. It also gives the physician who fills out the death certificate a list of conditions that should
be named as contributing factors to the veteran’s death.
During the pandemic the primary cause of death listed for many veterans has been COVID-19. But the
veteran’s service-connected conditions in most cases were contributing factors. COPD and diabetes, for
example, often are contributing factors. By having the doctor list a service-connected condition as a
contributing factor on the death certificate, the widow will not have any difficulty getting the DIC claim
approved. As a 100 percent permanent and totally disabled veteran, you are authorized a free death
insurance policy providing you filed for that benefit within two years after you received your rating award
letter. Locate the phone number for the insurance agency and keep it with the policy.
Then you need to compile all the documents listed below. The items and all pertinent information
should be kept in a folder.
 Will
 Do Not Resuscitate statement
 Obituary
 Funeral wishes
 Passwords for computers and other items
 List of people to contact other than family (old military buddies,
 etc.)
It’s also important to contact your nearest Casualty Assistance Office, which can help you file whatever
documents are necessary for retirement pay and other issues. If your significant other is not a member of
a Veterans Service Organization, locate the nearest VSO that helps with filing DIC claims and performs
graveside honors.
This list is by no means complete. However, it will give you a starting point and provide critical
information necessary to take care of the most time-sensitive items. AVVA offers a Paper Safe. Most
funeral homes have guides, and will provide additional guidance. Please take the time and make this one
of your priorities. As Vietnam veterans, we are all living on borrowed time. For more information, see
“Navigating the VA Widow’s Benefits Maze: Get the Facts and Don’t Give Up,” by Claudia Gary, in the
July/August 2019 issue of The VVA Veteran (http://vvaveteran.org).

(332) How To Win Your PTSD Claim without Diagnosis (Don't Fall for this common Grift!) - YouTube

it doesn't just apply to PTSD..WATCH this video!!

08-01-2021, 08:57 PM

My HealtheVet, VA’s online patient portal, gives you access to your VA health information so
you can understand and manage your VA care. Beginning in September 2021, My HealtheVet
Advanced accounts will be discontinued. If you have an Advanced account today and do not
upgrade to a Premium account, your account will revert to a Basic account. If that occurs, you will
lose access to the pharmacy features, including the ability to request and track your VA
prescription refills. That means… it’s time to upgrade to a Premium account. With a free Premium
account, you can securely access your VA health information, 24/7.

Using your My HealtheVet Premium account, you will be able to:
 Request VA prescription refills, track your VA medications, and access your current VA
prescriptions and prescription history.
 View, download and print your VA health information, reports and images from your VA
medical record.
 Send online secure messages to your VA care team to ask them non-urgent health
questions; ask to renew your medications; and send updates on your condition.
 View, schedule, reschedule and cancel VA appointments.

How to get started
If you are new to My HealtheVet, create an account by visiting the My HealtheVet website,
selecting Register, and filling out the required fields. Make sure to check the boxes verifying that
you are a VA patient and Veteran. If you are already a user, you may have a Premium account. If
you do, there will be a “P” icon next to your name. Also, if you currently use secure messaging on
My HealtheVet, you’re all set. Patients who use secure messaging already have a Premium
account.

Three ways to upgrade to Premium level
If you have an Advanced account, there are three ways to upgrade to Premium level: in person,
online or through a video appointment. Upgrading your account is free. If you want to upgrade in
person or through a video appointment, contact the My HealtheVet coordinator in your local VA
facility. Ask about upgrading to a Premium account. You can locate your VA facility’s contact
information through VA’s facility locator tool. To upgrade online, you’ll need to use your DS
Logon Premium or ID.me secure sign-in credentials. You can learn more about the online
upgrading process on the My HealtheVet blog post.

Effective August 5,2021 there are now 3 presumptive conditions for "particulate matter exposures during military service in several "Gulf War" regions that are likely to have caused or aggravated the following conditions:

Asthma

Sinusitis

Rhinitis (or Rhinosinusitis which is inflammation of the nasal cavity and paranasal sinuses)

Hopefully this is just a start but good news for many of our brothers and sisters out there

Airborne Hazards and Burn Pit Exposures - Public Health (va.gov)

Curious as to what the VA is considering adding to the presumptive list for "Burn Pit" we;;, here you go as of 11/15/2021

Conditions used as new process proof of concept

Rhinitis Completed

Sinusitis Completed

Asthma Completed

Conditions that may be reviewed during the pilot (Nov 21 - Apr 22)

Rare Cancers Under Review

Constrictive bronchiolitis Under Review

Acute eosinophilic pneumonia Under Review

Lung Cancer Under Review

Oral, Nasal and Pharyngeal cancers Under Review


Conditions that will be reviewed pending outcome of pilot results (Maybe after Apr 22)

Chronic obstructive pulmonary disease (COPD) Future Review

Emphysema Future Review

Idiopathic pulmonary fibrosis Future Review

Esophageal cancer Future Review

Laryngeal cancer Future Review

Note: List based on conditions possibly associated with deployment to Southwest Asia by National Academy of Science, Engineering
and Medicine

Information on this "Pilot" they speak of follows:

Secretary approved the draft presumptive conditions model on
October 26, 2021 and approved initiating the pilot from November 2021-April 2022 on October
29, 2021.

Pilot process: November 15, 2021-April 1, 2022

Conduct pilot progress check in and revise decision model to EESC
(as required): January 14, February 14, and March 14, 2022

Monthly updates to EBPC: January, February and March 2022

Decision brief of pilot to VAOB/VAEB: Last week of March 2022

Initiate implementation of new process: April 1, 2022

So basically what this means is that the VA is going to be examining Veterans to determine just what "presumptives" actually occurred due to exposure and which conditions scientifically match up so according to this we SHOULD see more presumptives added in April 2022

FOR IMMEDIATE RELEASE
Nov. 11, 2021
VA pilots evaluation model to determine potential exposure to environmental
hazards while serving

WASHINGTON — The Department of Veterans Affairs (VA) announced today it is
piloting a comprehensive military exposure model to consider possible relationships of
in-service environmental hazards to medical conditions. The goal of this new model is to
lower the burden of proof for Veterans impacted by exposures and speed up the
delivery of health care and benefits that they need.
The new model will continue to leverage scientific findings from the National Academies
of Science, Engineering, and Medicine (NASEM), available and relevant scientific
research data, surveillance of Veterans’ health outcomes, and adding the review of VA
claims data and military environmental research for trends and identify new concerns.
At the direction of the President, the first conditions this pilot will actively consider are
rare respiratory cancers and constrictive bronchiolitis. Consistent with the President’s
demands, VA anticipates answers on these conditions by mid-2022.
“We are seeking more information from Veterans, more evidence from more sources,
and looking to take every avenue possible to determine where a potential presumptive
illness based on military service location may exist in a more expedient and holistic
manner, “said VA Secretary Denis McDonough. “We want all Veterans who may have
been impacted to file a claim even if it was previously denied.”
The presumptive decision model pilot will run from Nov. 15 to April 1, 2022. VA will look
to use the results of the pilot to formalize the model after April 1, 2022. Over the last six
months, VA has extended benefits and services to Veterans impacted by military
exposures due to Agent Orange and particulate matter.
If a Veteran has a condition they believe is attributed to an event during military service,
they are highly encouraged to file a claim. More information about VA benefits and
eligibility, or how to file a claim may be found on VA’s website at www.va.gov or by
calling toll-free at 800-827-1000.