BOISE — Upon learning that the pharmacy benefit management organization that administers the TRICARE Pharmacy Program instituted changes that impact roughly 400,000 beneficiaries and cut out almost 15,000 pharmacies mostly in small communities, the Idaho Congressional Delegation pressed the U.S. Department of Defense’s Defense Health Agency (DHA) to ensure adequate patient access for servicemembers and covered veterans.
“While Express Scripts claims most patients will have access to pharmacies in their area, significant concerns remain that beneficiaries in rural areas, including Idaho, will encounter less availability that could undermine their quality of care,” the Delegation wrote.
“. . . reducing payments to community pharmacies hurts not just choice, but could be seen as a move to monopolize,” the letter continues. “Additionally, this could impact pediatric healthcare needs for families enrolled in TRICARE, because these children must go to independent pharmacies for specialized compounding services due to traditionally manufactured drugs not being able to meet their needs.”
“I have asked repeatedly for a stand-alone contract with Sandpoint Super Drug and ESI-Tricare as if my contracting agency never existed. I am losing customers daily because of this agreement with Tricare-ESI and larger corporate pharmacies. This is preventing me from meeting the prescription needs of many Tricare recipients in my community,” said Scott Porter, Pharmacist and owner of Sandpoint Super Drug, which serves the rural community of Sandpoint, Idaho, with a clientele base comprised of roughly 30 percent TRICARE patients, and whose contract to provide TRICARE benefits was abruptly cancelled.
Express Scripts, Inc. (ESI), the pharmacy benefit manager for TRICARE, has implemented pharmacy network changes that disproportionally harm small community pharmacies by cutting the reimbursement rate for prescriptions dispensed in-network. As a result, a number of pharmacies will no longer be able to afford to participate in the TRICARE pharmacy network. ESI made these changes unilaterally, terminating 2022 contracts two months early rather than allowing them to expire at the end of the year.
The Idaho Delegation is seeking answers to several questions to better understand the reasons for the abrupt changes, to understand the true size of the negative impact this decision will have on TRICARE beneficiaries, and to ensure adequate patient access for Idaho’s veterans and servicemembers who rely on small community pharmacies to meet their pharmaceutical needs.
Full text of the letter can be found below, or by clicking here.