The Latest TRICARE Philippines Fiasco or Mercury Drug, Now You See Them, Now You Don’t


Merriam-Webster defines Fiasco as – a complete failure; something that has failed. That pretty much explains the TRICARE Management Activities (TMA) implementation of TRICARE in the Philippines in general. But today we want to address one specific issue, pharmacy claims. Some might consider these actions by TMA to be fraud against beneficiaries but maybe it is just incompetence on the part of TMA and ISOS; you decide.

It seems that even for pharmacy the International SOS (ISOS) and TMA can’t get it right. For years we suggested that reputable and well known pharmacy chains be certified at the national level to increase access to care and to also save TMA hundreds of thousands of dollars in contractor expense. However TMA, not being able to think for themselves, always asked ISOS if it was possible and, because they were paid by the certification, ISOS always said no. Of course this meant thousands of additional certification claims for travel expenses increasing profits for ISOS; kind of like asking the Fox to guard the Hen House. Only after TMA got tired of overcharges and they changed the contract to eliminate reimbursement to ISOS by the certification did they agree and then they agreed to what they said was impossible for years. Now it seems that TMA and ISOS have added a new twist to their claims denial, ah, we mean approval process.

The first national chain certified was Mercury Drug one of the largest, if not the largest, national pharmacy chain in the Philippines and they add new stores every month. However TMA and ISOS have added a new twist to their denial of claims process. It seems as beneficiaries learn about new, but unpublicized rules, and find ways to overcome them, TMA has to develop more unpublicized rules to keep claim approvals as low as possible.

Beneficiaries are finding that claims for prescriptions filled at Mercury Drug are routinely denied and the EOB listed reason is 018 – PROVIDER NOT TRICARE AUTHORIZED FOR THIS SERVICE; how can that be possible if every outlet is certified as TMA and ISOS proclaim. Multiple complaints lodged with TMA and their contractors finally resulted in a response that this was not acceptable and should stop; but the jury is still out. The latest new unpublicized, can we call it secret, rule is to require beneficiaries to guess the actual address listed on the “Official” certified provider list that apparently includes each and every Mercury Drug store in the Philippines.

We are not allowed to see this “Official” certified provider list but instead, occasionally, have a modified and adjusted list posted on the internet. We say occasionally because ISOS has a bad habit of ignoring the contract requirement of posting it on the required dates and TMA has to be reminded by beneficiaries to tell the contractor to do their job. See Letter Asking for Address.

Since there are no individual Mercury drug outlets listed on the “Unofficial” list it becomes a crap shoot to guess what address ISOS may have decided to assign to any particular location. We also know from when Mercury was listed that addresses made absolutely no sense and in many instances ISOS listed the same drug store 3 or more times with slightly different addresses. By looking at the last Certified Provider List before individual Mercury outlets were removed we find that the Mercury Drug in question at “Mercury Drug – Robinson Angeles” was certified three times under three different but similar addresses.

  1. Robinsons Big R Supercenter. Mc Arthur Highway, Balibago, Angeles City, in the city of Pampanga.
  2. Robinsons Big R Super Center, Balibago, Angeles City, in the city of Pampanga.
  3. McArthur Hwy Balibago Angeles City, in the city of Pampanga.

Doing the same thing for the other Mercury Drug we find the address listed as:

  1. Mercury Drug Angeles Mac Arthur. Central Luzon in the city of Angeles Mac Arthur.
  2. Mercury Drug Corporation – McArthur Highway Branch. Central Luzon Drug Corporation, McArthur Highway, Salapungan, Angeles City, in the city of Pampanga. (May or may not be the same outlet as 1. Above but it is anyone’s guess.)

In the second instance, that’s like listing the address for a pharmacy in Phoenix, AZ as “Southwestern U.S.” No wonder Wisconsin Physician Services (WPS) has so much difficulty in finding a real address for Mercury drug stores and why they so often claim they are not certified. It only proves, once again the axiom on database management, Garbage in Garbage out, and ISOS seems to be the master at this. See the Actual Listings.

A possible explanation for initial denial of many pharmacy claims from Mercury may have been the result of WPS trying to follow the dictates of ISOS and match the address on the claim with an address on the “Official” but secret list. When they couldn’t find a match the claim was denied. Now that we questioned this and were told that it would stop, WPS may now have to ask the beneficiary to guess the address that ISOS chose to associate with a given Mercury outlet since it is likely that even ISOS can’t guess what it is.

Days ago we quarried TMA on why these claims are again being questions but to date no response. Since TMA has refused to place the promised employee on the ground, we remain the only overseas location with a major TRICARE population without local representation to respond to and resolve issues. So we have little choice but to wait and wait.

To further explore the issues with filing pharmacy claims we did a little research and found that according to TMA, pharmacies in hospitals are no longer certified unless the hospital pharmacy is specifically certified which is another secret change as for the previous 8 years all hospital pharmacies of certified hospitals were certified. See TMA’s FAQ.

A cursory look at the latest “Unofficial” Certified Provider List shows that the pharmacies at these hospitals are not certified and therefore prescriptions filled by them will be denied. There are many more but to many to list here.

  1. St. Luke’s Medical Center – Manila
  2. The Medical City – Manila
  3. Sacred Heart Medical Center – Angeles City
  4. Angeles Medical Center – Angeles City
  5. Angeles University Foundation Medical Center – Angeles City
  6. Chong Hua Hospital – Cebu
  7. Sacred Heart Hospital – Cebu
  8. Visayas Community Medical Center – Cebu
  9. Baypointe Hospital and Medical Center Inc – Olongapo
  10. Iloilo Doctor’s Hospital – Iloilo
  11. Our Lady Of Lourdes International Medical Center – Olongapo

So be aware that TMA may now and without any real warning, deny pharmacy claims from the majority of certified hospitals in the Philippines after honoring them for years and without any honest warning.

One more little tidbit of information that beneficiaries might find of interest. Looking at the ISOS TRICARE web page under providers for Philippine TOP Prime Remote the list is minute and there is not one pharmacy listed which means even Active Duty and other Prime patients will have to pay for their prescriptions and then file a claim. If, after years of searching, ISOS can’t find even one pharmacy for Prime patients, what chance do you think they found one for each of the four new limited access Closed Network areas?

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About TRICARE Overseas Philippines

We are U.S. Military retirees working to insure we obtain the medical benefit promised in spite of the Defense Health Agency.
This entry was posted in Certified Provider List, Closed Network, International SOS, Tricare Management Activity (TMA), Tricare Overseas Program Philippines, Wisconsin Physician Services (WPS). Bookmark the permalink.

6 Responses to The Latest TRICARE Philippines Fiasco or Mercury Drug, Now You See Them, Now You Don’t

  1. Richard Dakin says:

    As I have said before sometimes it would seem less stressful to drop Medicare and just put the money in the bank and go it alone. Out of the 24 years here we have paid our medical bills for about 15 years of that time, medicine included.

    Like

    • Robert Gilson says:

      I am still thinking about that, too, especially since I have zero plans to return to what has become a blatant police state.

      Like

  2. William Young says:

    I was one of the beneficiaries who received a denial on Mercury Drug not being an approved pharmacy provider, yet Mercury Drug is almost the only one that is listed and it was listed thruout the country, yet now my claims are returned denied for lack of approved pharmacy provider. This is outrageious. This is absolute fraud. This is my government representatives who are paid to carry out the law in regard to medical care acess and who are under contract to do so and TMA is the supervising entity required to ensure the delivery of the medical care and they have decided that they will rewrite the laws and do as they please with the aim of taking away all medical care to all the beneficiaries here in the Philippines and since none of our congressional members will stop the enfighting to realize what is going on the DOD is using TMA to have the medical monies returned to them to use as they please in building ships and aircraft not funded by the congress. We have a mess in the U.,S. and our country has become worse then a developing country. We have high up officials blantantly having their personal way with the tax payers monies and literally getting away with it. I am returning to the U.S. at the end of the year and when I get back I intend to walk into all my representatives offices and ask them why they are allowing TMA and the contractor ISOS to defraud the beneficiaries here. I will shout to the high heavens and I will get someones attention and with all the evidence gathered here just on this blog should be enough to hang TMA and ISOS. The only monies being paid for medical care here in the Philippines is the salaries of TMA and the contractor ISOS. The purpose of them all is the beneficiaries and they get nothing, no access to care nor drugs and they have caused the early deaths of many retirees here. Can anyone say this is the intended purpose of the law? I do not think so!! Nor do I think the tax paying citizens in the U.S. will thing so either. .

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  3. Mark says:

    I have been claiming my wife’s blood pressure medication for the last two years. The prescriptions have always been filled by the same Mercury Pharmacy. I just made a claim for her last 30 day supply. Now I guess I will have to wait and see if it will be paid or denied. When we were in the states she had her bp medicine prescription filled at a Navy Hospital pharmacy. Took only 10 minutes and paid nothing. My wife wants to got back to the states now, but I am holding out for awhile longer.

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  4. Walter 2 says:

    I may have to start trying the Tricare pharmacy non-reimbursement fiasco. The VA is sending me to 2 local doctors and there is no telling what they will prescribe, “Not in our formulary” is printed on the T shirts worn by pharmacy personnel. we’ll see.
    Walter 2

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  5. JEFF says:

    I was denied several pharmacy reimbursement claims submitted to WPS TRICARE-OVERSEAS. I had made purchases for medications at the “Mercury Drug Nepo Mart, located here in Angeles City, Philippines. WPS said this was not a Mercury Drug because it said “APU Drug Corp” on the top of the official receipt, and showed “Mercury Drug Nepo Mart” on the bottom? It took me over six months of writing letters and secured email messages, along with evidence that this was in fact a “Mercury Drug.” I sent WPS photos (in living color) of the store in question, a copy of an actual “price sticker” on the item, a copy of the “cash register receipt” showing “Mercury Drug”, and even a copy of the bag with the logo on it. Finally, I was reimbursed for this charge, along with other after this. Then, just recently, I sent a request for reimbursement from the same drug store, and I was now “denied”, saying this was not a “APU Drug Corp” “certified/approved” provider for Mercury Drug? Now, I am confused, all I can determine is that the representatives are trained to hope that patients will get tired and give up. I say…NOT!
    JEFF

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