Lawmakers Question Move to Shrink TRICARE Pharmacy Network by 27%

Lawmakers Question Move to Shrink TRICARE Pharmacy Network by 27%
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This article by Karen Jowers originally appeared on Military Times, the nation's largest independent newsroom dedicated to covering the military and veteran community.


Lawmakers are questioning Defense Department officials about the reduction in reimbursements for retail pharmacies in the Tricare network, expressing concern about the effects on military beneficiaries’ access to local pharmacies.


“These reductions may leave many retail pharmacies unable to participate in the Tricare Pharmacy Program, thus significantly impacting 9.6 million Tricare beneficiaries’ access to local pharmacies,” stated the Sept. 29 letter to Seileen Mullen, acting assistant secretary of defense for health affairs. The letter was signed by 100 senators and representatives.


The lawmakers noted that over 90% of Americans live within five miles of a community pharmacy, and 76.5% of pharmacies in rural areas are independent community pharmacies.


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Defense officials confirmed that 27% of the pharmacies in the Tricare retail pharmacy network are leaving as of Oct. 24. Those leaving are community and independent pharmacies.


“Express Scripts Inc., the pharmacy contractor responsible for maintaining the Tricare pharmacy network, has said that of the roughly 55,586 network retail pharmacies, 14,963 will not continue participation in the network,” said Peter Graves, spokesman for the Defense Health Agency, in a statement provided to Military Times.


“Despite this change, the Tricare retail network will continue to meet or exceed Tricare’s standard for pharmacy access,” Graves said. CVS and Walgreens, as well as many grocery store pharmacies and smaller chains continue to participate.


“Beneficiaries will continue to have many convenient, local in-network options for filling their medications, including those beneficiaries in rural locations,” he said. “Nearly 95% of beneficiaries will maintain access to at least two network pharmacies within 15 minutes from their home, and 99.8% will have access within 30 minutes.”


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Tricare doesn’t participate in contract negotiations between Express Scripts and retail pharmacies, he said.


In a statement provided to Military Times, Express Scripts said the company “offered new terms and conditions to pharmacies for participation in the new Tricare pharmacy retail network, and nearly 41,000 chain, grocery store and independent pharmacies agreed to participate. The new network will include at least 7,000 community pharmacies.


“The terms and conditions offered to pharmacies represented our best and final rates, and aligned with the economics necessary to provide the value to the Tricare program and ensure beneficiaries have access to the best possible prices for their prescription drug needs,” officials stated.


Officials said they structure the network terms and conditions “to ensure the ongoing balance between access, quality, and cost in the Tricare pharmacy network.”


The changes are the result of their effort “to ensure the best value and care for the Department of Defense, beneficiaries and taxpayers.”


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The changes take effect Oct. 24, rather than at the end of the year, and the lawmakers also questioned that timing, which may force many beneficiaries to change pharmacies at a time when they receive annual vaccinations.


Karen Ruedisueli, director of health affairs in government relations for the Military Officers Association of America, said that organization is concerned about the impact on those in rural areas. “We are hearing from families who will have to drive past a community pharmacy and/or Walmart and then another 20 to 30 miles to get to a network pharmacy,” she said. Walmart left the Tricare pharmacy network in December 2021.


She said many long-term-care pharmacies are among the independent pharmacies leaving the Tricare network, creating a barrier to access for long-term-care residents, including those in assisted living and post-inpatient rehabilitation facilities serving the elderly and those with disabilities.


“MOAA is very concerned about the impact on long-term-care residents such as those in assisted living. They don’t have the option of switching to a retail pharmacy or mail order and, for some, this cut to the network will present an insurmountable barrier to using their earned Tricare pharmacy benefit.”


Graves, spokesman for DHA, said Express Scripts began notifying affected beneficiaries about the changes in mid-September.


“Anyone with a prescription at an impacted pharmacy should transfer it to a new network pharmacy to avoid paying the full cost of the prescription up front or having to file a claim for reimbursement,” he said.


“Beneficiaries who have a specialty medication prescription with one of the departing pharmacies will receive assistance from Express Scripts in transferring those prescriptions to a network pharmacy.”


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