The Defense Department’s acting top health official said priorities for him, as well as Defense Secretary Robert Gates, include sustaining wartime medical support, improving wounded warrior care and coordinating better delivery of services across the $50 billion-a-year military health system.

The health system’s top priority, said Dr. George Peach Taylor, Jr., is ensuring that fighting forces have the medical teams on scene that they need – properly equipped, properly staffed and with the most advanced technology and procedures available anywhere. The result is surviving what was once unsurvivable.

A second priority is that warriors get the best possible care to recover from injuries, particularly lost limbs, traumatic brain injury and post-traumatic stress disorder — the signature injuries of current wars.

For amputees, Taylor noted the extraordinary gains in prosthetics but also in the work of the Armed Forces Institute of Regenerative Medicine and partners such as Wake Forest University so that, perhaps within a decade or even five years, they “can actually build new fingers and new ears, new noses and new toes, new feet and, eventually, new legs.”

Meanwhile, field-level policies have been changed to better protect those exposed to bomb blasts, so all receive medical evaluations after an incident and are not returned to the fight with undetected injuries.

Research is advancing to find biomarkers to detect brain injury. DoD and VA continue to partner on psychological health issues, exploring alternative therapies and more effective clinical guidelines to PTSD. Several thousand behavioral health specialists have been hired into the military direct care system and they partner routinely with civilian mental health experts.

Taylor, a retired three-star officer and former Air Force surgeon general, is deputy assistant secretary for force health protection and readiness. But until Congress confirms Dr. Jonathan Woodson, Obama’s nominee to be assistant secretary of defense for health affairs, Taylor is performing those duties. So he is DoD’s top health official and Gates’ principal advisor on health budget and policy including TRICARE.

On whether higher TRICARE fees are in the offing, Taylor said, “Every year for most of the years I’ve been around, the department has proposed changes to the benefit structure.”

Congress has blocked most attempts to raise out-of-pocket TRICARE costs, but key lawmakers see rising health care costs as a sign that it may be time to allow at least modest fee hikes, which DoD is could propose in the 2012 budget.What might be proposed is “in department negotiations,” Taylor said. He said he doesn’t yet know what DoD will sign out, or what the White House will accept.

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“It’s quite possible the budget won’t contain any benefit changes,” Taylor said.  Or “in terms of the core enrollment benefit, it could be that it will contain some pharmacy benefit changes.”

Taylor noted that Gates is “very well on record that health care costs are eating us alive and we need to do something about it.  There are only limited things you can do…You can decrease the total number of people that you have; you can change the benefit; you can change the use [of it] and, lastly, the actual technology or state of medicine.”

Looking at past proposals to raise health fees and co-payments, the most successful and accepted have sought to change patient behavior, he said, specifically the tiered co-payments adopted for the pharmacy benefit.

Patients pay higher co-pays today if they fill prescriptions in the TRICARE retail network where a 90-day supply costs TRICARE an average of $294.  Lower co-pays are set for TRICARE’s mail order program, now called “home delivery.”  A 90-day supply of mail-order drugs costs TRICARE an average of $169, or 42 percent less than the neighborhood drug store.

Similarly, patients who use generic rather than brand name drugs see even lower co-payments.

The tiered structure for pharmacies changed behavior without “impeding the benefit,” Taylor said. “So we continue to explore those kinds of options.”

The new goal for TRICARE pharmacy plan is to more than double usage of home delivery so 500,000 prescriptions are filled by mail each week.  The potential yearly savings would be $238 million, Taylor said.

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