The new restrictions include both independent and chain pharmacies.
On October 24, 2022, Cigna-owned pharmacy benefit manager (PBM) Express Scripts will be removing nearly 15,000 pharmacies from the list of eligible pharmacies available to Tricare beneficiaries, many of which are pharmacies are independent community pharmacies in underserved rural and urban communities.1
Express Scripts administers prescription benefits for Tricare on behalf of the Department of Defense (DOD). The National Community Pharmacists Association (NCPA) has issued a statement of appeal to the DOD to return access to impacted pharmacies and protect pharmacy access for the 400,000 beneficiaries impacted.
According to the NCPA,2 pharmacies learned about the change from patients who brought letters from Express Scripts into the pharmacy. Both pharmacists and patients surprised, having expected the contract to remain in place through the end of 2022.
Patients have come forward to express frustration with the change, from the short notice to the way it has hindered access to cancer medications and the “unacceptable alternatives” suggested by Express Scripts to patients’ current pharmacies.2 Another wrinkle is that many independent pharmacies work with long-term care facilities providing a number of services, including compliance packaging. Tricare does not offer long-term care pharmacy benefits, but beneficiaries in facilities with such partnerships were able to receive benefits. The change will leave many without these services, and many others will be left to manage medications on their own.
“Tricare patients earned their benefits, and it is imperative that they retain convenient access to their health care providers,” said B. Douglas Hoey, RPh, MBA, CEO of NCPA in a letter to United States Defense Secretary Lloyd Austin. “With a vast majority of independent pharmacies out of network, along with large chains such as Kroger and Walmart, it is difficult to see how Cigna/Express Scripts is. Meeting even the reduced access standards in its new contract with DOD.”1
NCPA has also taken the issue to legislators. Senator Jon Tester (D-Montana), chairman of the Senate Committee on Veterans’ Affairs, called the network changes “unacceptable”1 and urged the DOD to take immediate steps to address concerns. A group of 100 bipartisan members of both the House and Senate sent a letter, led by Senator Tom Cotton (R-Arkansas) and Representative Buddy Carter (R-Georgia) asking Express Scripts for answers. Representative Mike Johnson (R-Louisiana) also sent a letter asking for justification at the early termination of the 2022 contract as well as for clarification on how the DOD would safeguard adequate pharmacy access.
Hoey concluded his letter to Secretary Austin by urging the DOD “to take steps to ensure all pharmacies that were included in the 2022 Tricare network remain in the 2023 network at the 2022 terms and conditions. Without this action, access to needed medications for Tricare beneficiaries is in peril.”