Phyllis Ramm, wife of an Air Force retiree, got a surprise Aug. 7 when she called the Keesler Air Force Base pharmacy to refill routine prescriptions. She learned that some popular brand-name drugs no longer would be dispensed on base, after patients get a final 30-day supply.

The Air Force directed its 74 pharmacies in July to drop Allegra, for allergy relief, and Celebrex, for arthritis pain, from their formulary, and to recommend instead lower-cost alternatives of equal effectiveness.

Patients using Allegra, a non-drowsy antihistamine, can take a generic form of Claritin instead, said Maj. Gen. Joseph E. Kelley, Air Force assistant surgeon general, in a July memo to commands. Users of Celebrex and Bextra, “cox-2 inhibitors” for arthritis, should switch to Vioxx. Patients using the insulin Humalog should be offered Novolog instead.

The changes, meant to control spiraling drug costs without sacrificing patient care, reflect “an extremely challenging budget year for the Air Force Medical Service,” said Kelley.

The change also upset some patients, including Phyllis Ramm’s husband.

“My feeling is that our entitlement, of which pharmaceutical service is a part, is being chipped away,” said retired Chief Master Sgt. Charles Ramm, a resident of Gautier, Miss.

Air Force pharmacies are only the first to tighten drug inventories in this way. The Army and Navy are expected to make similar moves this fall, during a more formal process to shape a Uniform Formulary.

Bob Washington of the Fleet Reserve Association, who will serve on the beneficiary panel, said the Air Force’s change in base formulary last month looks like an attempt to “circumvent” this process.

Air Force officials said they worried about that perception but still needed to act.

Frank Rohrbough, with the Military Officer Association of America, said a “top down” formulary change, typically made at base level, hints at the severity of a medical budget shortfall hitting all the services this year.

The Military Coalition, a group of service and veteran associations, complained of the formulary shift in a July 26 letter to Lt. Gen. George Taylor, Air Force surgeon general. The Air Force, it said, is risking higher drug costs if more patients use the Tricare retail network where costs are higher for the government and patients. Also, while the Air Force takes credit for standardizing its own base formulary, the changes have created “regrettable interservice disparities,” the letter said.

One coalition representative said the Army and Navy can’t be thrilled by the prospect of filling Allegra and Celebrex prescriptions for Air Force beneficiaries, which will aggravate their own budget challenges.

Samples said he hopes patients instead try replacement medicines, the generic version of Claritin, for example, which costs the military pharmacies seven cents a pill, versus Allegra which costs 96 cents.

The mix of drugs available on base is the only element of pharmacy costs the services can control, he noted. But if during the formulary review process, Assistant Secretary of Defense Dr. William Winkenwerder directs a reversal, he said, “the Air Force will salute sharply and change to the [whatever is the] DOD Uniform Formulary.”

— To comment, write Military Update, P.O. Box 231111, Centreville, VA 20120-1111, e-mail or visit

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