![]() The transition is especially problematic for a small group of Tricare beneficiaries who are chronically ill, have a disability, and receive infusion medications in their homes, according to pharmacists. “Our charge is to ensure Tricare beneficiaries can access their prescription medication safely, affordably, and conveniently, and at the best value for the Department of Defense and taxpayers,” Sessions said. Sessions said Express Scripts has a team dedicated to contacting the “small percentage of beneficiaries that may be impacted by these changes” and helping them move their prescriptions. In a separate email, Express Scripts spokesperson Justine Sessions said the decision to leave the network was “up to the pharmacy and/or the wholesalers that negotiate on their behalf.” She added that roughly 80% of pharmacies being dropped from the network had fewer than 50 prescription claims in the past six months from Tricare and that 25% had none. “Beneficiaries will continue to have many convenient, local in-network options for filling their medications, including those beneficiaries in rural locations.” “The Tricare retail network will continue to meet or exceed Tricare’s standard for pharmacy access,” Graves said. Roughly 95% of beneficiaries will have access to at least two network pharmacies within a 15-minute drive, he said, and “99.8%” will have access within 30 minutes. Peter Graves, a spokesperson for the Defense Health Agency, which oversees medical care and services for 9.6 million beneficiaries, including service members, military retirees, and their families, said the Pentagon does not participate in contract negotiations between its pharmacy benefit manager and retail pharmacies.īut, he said in an emailed statement, the changes will not inconvenience many of the people in the program. Subscribe to KFF Health News' free Morning Briefing. While acknowledging that the Defense Department is under pressure to control health care costs, Karen Ruedisueli, the association’s director of government relations for health affairs, called the change “unprecedented and shortsighted.” The Military Officers Association of America, an advocacy group for active-duty and retired personnel, said it was pressing for a reversal of the decision. “This was a very botched rollout of this new network and unfortunate, ultimately, for the patients,” she said. But they were surprised by the early ejection, said Ronna Hauser, senior vice president of policy and pharmacy affairs at the National Community Pharmacists Association. Many of the affected pharmacies knew they would be dropped from the network at the end of the year because they didn’t accept Express Scripts’ terms, which included reduced reimbursement rates. Jon Tester (D-Mont.), chair of the Senate Veterans’ Affairs Committee, said: “No longer able to rely upon their local pharmacy to access needed medications and in-person pharmacist counseling, they would be forced to drive long distances to find corporate in-network pharmacies or be funneled into Express Scripts’ mail delivery program. In a September letter to the Defense Department, U.S. The move has upset customers and many independent pharmacies and has raised concerns among some service member advocates and lawmakers, especially those in rural states, who feel it disproportionally affects rural veterans. You have to be in their special pharmacy system.”Ībout 27% of all pharmacies in the Tricare network are no longer covered, leaving more than 400,000 military beneficiaries affected. ![]() “But that was kind of a mess because you can’t just go into CVS and get a $1,500 medicine. “Express Scripts told us, ‘You can just go to CVS,’” Michael Spatz said. And some larger chains require patients to use a branch of their business known as a specialty pharmacy for pricey or scarce medications for complex diseases. Michael Spatz, because the breast cancer drug is not carried by every pharmacy. That decision created problems, according to Doris’ husband, Dr. Many of them were small, independent pharmacies, like Neighborhood Pharmacy of Del Ray, where Spatz was a customer. 24, when Express Scripts, the pharmacy benefit manager for Tricare, dropped nearly 15,000 pharmacies from its network. ![]() Spatz found a local pharmacy in her Alexandria, Virginia, neighborhood and was getting the life-preserving medicine there.
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