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HYDE-SMITH, COLLEAGUES QUESTION TRICARE PRESCRIPTION CHANGES
Lawmakers Concerned About Shrinking Pharmacy Network for TRICARE Patients & Their Families
WASHINGTON, D.C. – U.S. Senator Cindy Hyde-Smith (R-Miss.) today joined U.S. Senator Tom Cotton in seeking answers from the Biden administration regarding TRICARE beneficiaries’ ability to maintain access to local pharmacies.
In all, 18 Senators signed a letter to Seileen Mullen, the Acting Assistant Secretary of Defense for Health Affairs, which raises questions about Express Scripts reducing reimbursements for prescriptions dispensed at in-network retail pharmacies for 2023, which may force many retail pharmacies out of the TRICARE Pharmacy Program and disrupt service for beneficiaries who rely on independent community pharmacies.
“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,” the Senators wrote.
The Senators’ letter also questions the early expiration of 2022 pharmacy contracts, which has caused confusion and disruption for TRICARE beneficiaries who rely on independent community pharmacies that will no longer being included in the 2023 TRICARE retail pharmacy network.
The Senators sought details on future retail pharmacy participation in the program and access to in-person pharmacy services.
“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,” the Senators concluded.
This inquiry is supported by the Mississippi Independent Pharmacies Association, National Community Pharmacies Association, and the American Pharmacists Association.
Other Senators signing the letter included Roger Marshall, M.D. (R-Kan.), Charles Grassley (R-Iowa), Steve Daines (R-Mont.), John Boozman (R-Ark.), Marsha Blackburn (R-Tenn.), Shelley Moore Capito (R-W.Va.), John Thune (R-S.D.), Tommy Tuberville (R-Ala.), Jerry Moran (R-Kan.), Mike Rounds (R-S.D.), John Barrasso (R-Wyo.), Deb Fischer (R-Neb.), Mike Braun (R-Ind.), John Hoeven (R-N.D.), Bill Hagerty (R-Tenn.) and Cynthia Lummis (R-Wyo.).
Read the text of the letter below.
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.
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