Nearly a third of the independent pharmacies that were dropped from the Tricare retail pharmacy network in October have opted to rejoin the network, according to officials from Express Scripts, which manages the prescription plan.
“We are pleased that an additional 4,356 independent pharmacies accepted the contract terms we offered in December and will rejoin the Tricare network this month,” said Justine Sessions, spokeswoman for Cigna/Express Scripts. As of Jan. 15, there will be more than 42,000 pharmacies in the Tricare network, including nearly 12,000 independent pharmacies, she said.
In October, 14,963 independent pharmacies — out of a total of 55,586 retail pharmacies in the network — dropped out of Tricare, mostly because of what they perceived as low reimbursem*nt rates. But a number of community drug stores never even received the proposed 2023 contract, which Express Scripts sent by fax earlier in 2022, according to the National Community Pharmacists Association.
In addition to fewer independent retail pharmacies, all of the more than 2,200 Kroger pharmacies left the network Jan. 1. Kroger officials described the Express Scripts drug pricing model as “unsustainable” for Kroger and its customers.
Reimbursem*nt rates have been the key issue for the independent pharmacies, too, although earlier in 2022, more than 7,000 independent pharmacies accepted the proposed Tricare network rates for 2023.
Although the number of pharmacies has gone from 55,586 to 42,000, “approximately 98% of all Tricare beneficiaries have an in-network pharmacy within a 15-minute drive of their home,” said Peter Graves, spokesman for the Defense Health Agency.
Under the new Tricare pharmacy contract that began Jan. 1, Express Scripts must have at least one pharmacy within 15 minutes driving time of 90% of the beneficiaries.
Graves said Express Scripts ‘has consistently exceeded Tricare’s access standards established in their government contracts with the [Defense Health Agency] over time. The access standard is measured across the entire network and the DHA remains confident in our ability to meet and exceed those standards.”
The contract allows Express Scripts “to use its own discretion in contracting with pharmacies to establish a competitively priced network that meets contract access standards,” he said, and any realized savings are passed directly to the government.
RELATED
100 lawmakers question changes affecting access to Tricare pharmacies
Nearly 15,000 community and independent pharmacies declined to accept new terms, including reimbursem*nt rates, and will leave the Tricare network.
By KarenJowers
Not everyone is pleased with the outcome.
The decisions made by the Defense Health Agency and Express Scripts/Cigna “have resulted in thousands of active duty and retired service members losing access to their established and cherished local community pharmacies, forcing veterans to travel sometimes long distances to access their medications,” wrote Sen. James Lankford, R-Okla., in a Jan. 3 letter to officials at the Defense Health Agency, Express Scripts and Cigna Corp.
“In this instance, money has truly come before health of service members, which is disappointing to see in real time.”
Over the past few months, other lawmakers have written to defense officials expressing concern over the shrinking pharmacy network. Lankford urged the officials to “be up front about how you are actually rolling out the new contract — without negotiation, favoring large chain pharmacies and urban communities, and without real action to remedy any of the problems raised by dozens of members of Congress.”
He noted that even with the temporary reopening of the network, allowing pharmacies to rejoin, “there were very few to no changes made to contracts offered to pharmacies who were previously cut from the network. … Pharmacies were overwhelmingly offered non-negotiable contracts with reimbursem*nt rates far below cost that would have resulted in significant losses for nearly every prescription filled,” Lankford wrote.
While the vast majority of beneficiaries still have access to a retail pharmacy, among those who are negatively affected are people with chronic, serious health conditions, said Karen Ruedisueli, director of health affairs in government relations for the Military Officers Association of America.
“We’re hearing that their access has been reduced,” she said, and for the elderly who have challenges with transportation and mobility, reduced access hits them much harder.
“People assumed this benefit was out there and would protect them in the event of a catastrophic diagnosis or accident, or with increased needs once they got older,” Ruedisueli said. “This change has really cut the value of the benefit in that regard.”
The previous Tricare contract had retail pharmacy access standards specific to urban, suburban, and rural areas, she noted.
Those tiered standards are still required in Medicare Part D plans, she said, which also have requirements for long-term-care pharmacies to be included in the network. And the Blue Cross Blue Shield federal employee health plan has more than 55,000 pharmacies in its retail network, similar to the previous size of the Tricare network.
“Now we have a Tricare network that’s much worse than the benchmarks that are out there,” Ruedisueli said.
About KarenJowers
Karen has covered military families, quality of life and consumer issues for Military Times for more than 30 years, and is co-author of a chapter on media coverage of military families in the book "A Battle Plan for Supporting Military Families." She previously worked for newspapers in Guam, Norfolk, Jacksonville, Fla., and Athens, Ga.
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