New Express Scripts policy will reduce prescription reimbursements for 9.6 million TRICARE members in 2023
WASHINGTON — U.S. Senator Tommy Tuberville (R-AL) joined 15 of his Senate colleagues in a letter to Seileen Mullen, Acting Assistant Secretary of Defense for Health Affairs, seeking answers about TRICARE beneficiaries’ ability to maintain access to local pharmacies. The letter also notes that 2022 pharmacy contracts will expire on October 24, rather than the end of the year—reducing community pharmacy options for TRICARE patients and their families.
“Pharmacists continue to be one of the most accessible health care providers in the United States,” wrote the Senators.“Over 90 percent of Americans live within five miles of a community pharmacy, and 76.5 percent of pharmacies in rural areas are independent community pharmacies. As you know, in addition to dispensing medications and vaccines, community pharmacies provide services that lead to better health outcomes, lower overall administrative fees, and valuable in-person consultations with a healthcare provider,” they continued.
Joining Senator Tuberville in the letter are U.S. Senators Tom Cotton (R-AR), Roger Marshall (R-KS), Cindy Hyde-Smith (R-MS), Chuck Grassley (R-IA), Steve Daines (R-MT), John Boozman (R-AR), Marsha Blackburn (R-TN), Shelley Moore Capito (R-WV), John Thune (R-SD), Jerry Moran (R-KS), Mike Rounds (R-SD), John Barrasso (R-WY), Deb Fischer (R-NE), Mike Braun (R-IN), and Cynthia Lummis (R-WY).
A copy of the letter can be found below.
September 28, 2022
The Honorable Seileen Mullen
Acting Assistant Secretary of Defense for Health Affairs
Defense Health Agency
7700 Arlington Boulevard
Falls Church, VA 22042-5101
Dear Acting Assistant Secretary Mullen,
We write to request information regarding the Department of Defense Health Agency’s (DHA) monitoring of TRICARE beneficiaries’ access to retail and community pharmacies.
It has been brought to our attention that Express Scripts has reduced reimbursements for prescriptions dispensed at in-network retail pharmacies for 2023. 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. Most recently, Express Scripts notified pharmacies and beneficiaries that current 2022 pharmacy contracts will expire October 24, 2022, rather than the end of the year. This will only further reduce the pharmacy network for TRICARE patients and their families, and may force beneficiaries to change pharmacies at a time when many receive annual vaccinations.
Pharmacists continue to be one of the most accessible health care providers in the United States. Over 90 percent of Americans live within five miles of a community pharmacy, and 76.5 percent of pharmacies in rural areas are independent community pharmacies. As you know, in addition to dispensing medications and vaccines, community pharmacies provide services that lead to better health outcomes, lower overall administrative fees, and valuable in-person consultations with a healthcare provider.
To ensure TRICARE beneficiaries maintain access to local pharmacies, we respectfully request answers to the following questions.
- How is DHA monitoring current and future retail pharmacy participation in the TRICARE Pharmacy program?
- If future in-network pharmacy participation decreases, what steps will DHA take to ensure adequate access to in-person pharmacy services for TRICARE beneficiaries?
- Terminating the 2022 pharmacy contracts two months ahead of schedule will likely lead to a disruption of care for Tricare beneficiaries. What reasons has Express Scripts given DHA for terminating the 2022 contracts early? Please outline what oversight DHA has over Express Scripts, as well as what authority DHA has given Express Scripts to make these contract changes.
Thank you for your attention to this important matter. Due to the patient access and safety concerns expressed above, we look forward to receiving your response and working with you to ensure TRICARE beneficiaries continue to receive the utmost care from trusted, local health care professionals.
Senator Tommy Tuberville represents Alabama in the United States Senate and is a member of the Senate Armed Services, Agriculture, Veterans’ Affairs, and HELP Committees.