Lawmakers concerned about shrinking pharmacy network for TRICARE patients, their families.

On Thursday, U.S. Senator Cindy Hyde-Smith (R-MS) joined Senate colleagues in a letter to Seileen Mullen, the Acting Assistant Secretary of Defense for Health Affairs, seeking answers about TRICARE beneficiaries’ ability to maintain access to local pharmacies.

The letter 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.

“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,” the senators wrote.

“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,” the lawmakers continued. “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.”

The Senators state that pharmacists continue to be one of the most accessible health care providers in the United States.

Over 90% of Americans live within five miles of a community pharmacy, and 76.5% 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 group of lawmakers ask answers to the following questions to ensure TRICARE beneficiaries maintain access to local pharmacies: 

  1. How is DHA monitoring current and future retail pharmacy participation in the TRICARE Pharmacy program? 
  2. If future in-network pharmacy participation decreases, what steps will DHA take to ensure adequate access to in-person pharmacy services for TRICARE beneficiaries? 
  3. 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. 

Click here to view the full letter.