![]() Rosenbloom explained that the email notice gave beneficiaries two choices: one click for other in-network pharmacies, and one click for mail order. The letter changed the effective date instead of January 1, beneficiaries had to find a new pharmacy by October 24. The following month, TRICARE informed the 400,000 affected beneficiaries that they needed to find a new pharmacy for their medications, because their pharmacy “decided to leave” the network. Nearly 15,000 pharmacies were eliminated from the network. In August, Express Scripts kicked several pharmacies that didn’t accept the offer out of the TRICARE network, along with those to whom the offer was never even sent. “ The Federal Trade Commission opened an investigation into the PBM industry in June, in part looking into business practices that could be seen as anti-competitive.” “The Defense Department is allowing contractors to hold up pharmacies, to say, ‘Either you accept a money-losing contract or take the blame for not serving veterans.’” “Some pharmacies did accept the contract because they didn’t want to abandon veterans,” said Rosenbloom. “This is the 21st century,” Rosenbloom said.Įxpress Scripts indicated in the notice that pharmacies had 14 days to sign the contract and return via email, or they would be out of the TRICARE network. He also noted that it was faxed to the pharmacies involved. Only selected pharmacies received this deal Rosenbloom surmised that they were primarily in rural areas. ![]() The contract would make it mostly unprofitable for pharmacies to serve TRICARE beneficiaries. The notice said that, beginning January 1, TRICARE would dramatically reduce its reimbursement rate for prescriptions, and eliminate the dispensing fee. This became important background when, in mid-July, TRICARE sent a notice to certain pharmacies in the TRICARE network. PBMs are supposed to use their negotiating skills to secure discounts on prescription drugs for health plans like TRICARE.īut Express Scripts, which Cigna purchased in 2018, also owns the largest mail-order pharmacy in the United States. This includes coverage for a subset of military retirees or family members in long-term care facilities. The TRICARE program, which serves 9.6 million Americans, signed a new five-year contract last year with Express Scripts to manage its prescription drug benefit. ![]() That’s a more difficult climb than getting folded into the manager’s amendment, even for an amendment that would block something that so clearly presents a hardship to military families. ![]() That means that in order to prevent Express Scripts’ TRICARE action, senators will have to get the Lankford amendment voted on and passed. James Lankford (R-OK), did not make it into a manager’s amendment, which will become the baseline bill on the Senate floor. Senators had hoped to insert an amendment that would remedy the issue into the National Defense Authorization Act (NDAA), which will likely be advanced during the lame-duck session. “The DOD should not be behaving in this way, or allowing its contractor to behave in this way, for what appears to be a money grab,” said Alan Rosenbloom, president and CEO of the Senior Care Pharmacy Coalition, a group of 325 long-term care pharmacies, which primarily serve patients in nursing homes and assisted-living facilities. Critics say the maneuver is a naked attempt by Express Scripts, the Cigna-owned PBM, to steer beneficiaries toward its own market-leading mail-order pharmacy.Īdvocates and politicians from both parties have appealed to the Defense Department, which runs the TRICARE Pharmacy Program that was affected by this change. pharmacy benefit managers (PBMs)-the middlemen that handle the vast majority of prescription drug plans in the United States-has instituted a scheme that has left roughly 400,000 active-duty and retired military households scrambling for a new pharmacy provider within the next week. Critics say the company is steering them toward its own mail-order pharmacy. Express Scripts has forced 400,000 beneficiaries to find a new prescription filler.
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