With just days before 15,000 community and independent pharmacies will leave the Tricare retail pharmacy network, questions remain about the impact on patients’ ability to get their medications.
Other changes, coming with the new year, will affect those who rely on specialty medications for chronic, complex conditions such as cancer, rheumatoid arthritis, multiple sclerosis and other diseases.
On Monday, Tricare and Express Scripts will shrink the pharmacy network, affecting an estimated 400,000 Tricare beneficiaries, according to the National Community Pharmacists Association. Of the roughly 55,586 retail pharmacies in the Tricare network, 14,963 will leave after refusing to accept the terms for reimbursement and other conditions.
Those pharmacies will now be out of network, and beneficiaries who continue to use them will pay full price for their medications then file for reimbursement, which is subject to the deductible as well as a higher out-of-network cost share, said U.S. Public Health Service Cmdr. Teisha Robertson during a Tricare pharmacy webinar Oct. 20. Robertson herself is a pharmacist in the pharmacy operations division at the Defense Health Agency.
The loss of those almost 15,000 in-network pharmacies has raised alarms.
“I live in a rural area and Express Scripts is cancelling the in-network status [of] local pharmacies, which in some cases means a patient would have to drive up to 50+ miles to access an in-network pharmacy,” wrote one Minot, North Dakota, pharmacist on a Change.org petition started by the Georgia Pharmacy Association.
“This does NOT benefit the patient — especially with the high prices of gas and having to drive two hours round trip to fill a prescription.”
The petition had garnered 3,614 signatures as of Oct. 21.
Lawmakers have written to Secretary of Defense Lloyd Austin about their concerns, as have several pharmacy associations.
“Tricare patients earned their benefits, and it is imperative that they retain convenient access to their health care providers,” wrote B. Douglas Hoey, chief executive officer of the National Community Pharmacists Association, in an Oct. 18 letter to Austin.
“With the vast majority of independent pharmacies out of the network … it is difficult to see how Cigna/Express Scripts is meeting even the reduced access standards in its new contract with DoD,” Hoey wrote. “We therefore urge you to take steps to ensure all pharmacies that were included in the 2022 Tricare network remain in the 2023 network at the 2022 terms and conditions.
“Without this action, access to needed medications for Tricare beneficiaries is in peril.”
No response has been received from the Defense Department, a spokeswoman said.
Despite the change, “the Tricare retail network will continue to meet or exceed Tricare’s standard for pharmacy access,” Peter Graves, spokesman for the Defense Health Agency, told Military Times earlier. CVS and Walgreens, as well as many grocery store pharmacies, wholesale warehouse stores and smaller chains, including some independent neighborhood pharmacies, continue to participate.
“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,” he said.
In mid-September, Express Scripts sent a letter notifying affected beneficiaries of the change. The letter contained a list of other network pharmacies nearby. As of Oct. 24, beneficiaries can also use the Find a Pharmacy tool to find retail network pharmacies in their area. That online search tool will be updated by Express Scripts once the network changes go live, officials said.
For those who have a prescription at one of the pharmacies leaving the network and would like to transfer it to a new retail network pharmacy, officials advise three different ways to move those prescriptions:
- Take your medicine bottles to another participating network pharmacy. The pharmacy will inform you of their process.
- Call your doctor’s office. Ask them to send your prescription to your new in-network pharmacy.
- Call your new in-network pharmacy and ask them to transfer your prescription.
Other options include using the Tricare Pharmacy Home Delivery program or a military pharmacy. At military pharmacies, you can get up to a 90-day supply of most covered drugs at no cost.
There are co-pays required for those who use home delivery or go to any retail network pharmacy. Visit the Tricare Costs page to see pharmacy co-payments for your health plan.
Changes for specialty drug prescriptions
Beginning Jan. 1, Accredo will be the primary Tricare in-network specialty pharmacy, and beneficiaries must get their specialty medications from a pharmacy in the network.
Until this change, prescriptions for these specialty drugs for chronic, complex conditions such as cancer, multiple sclerosis, rheumatoid arthritis and hepatitis C were filled at a variety of locations, including a number of individual retail pharmacies, and through the Express Scripts mail-order pharmacy.
It’s not clear whether those who get their specialty drugs filled at one of the pharmacies leaving the Tricare pharmacy network Monday will have any leeway to be able to continue to get their prescriptions until Jan. 1, but the Accredo service is already available for those who want to switch before Jan. 1.
It’s anticipated that Accredo will fill almost all of these specialty prescriptions and that it will save money for the Defense Department.
“We don’t oppose these moves to save money as long as people are still able to access their benefit,” said Karen Ruedisueli, director of government relations for health affairs at the Military Officers Association of America. “There are questions about whether the most vulnerable people will be able to access their benefit.”
Specialty drugs are usually self-administered, high-cost injectable or oral drugs. They can require clinical training to administer; they may need special storage and handling; and aren’t available from many retail pharmacies.
Express Scripts is the parent company of Accredo Health Group, and Cigna and Express Scripts merged several years ago.
According to Accredo’s website, it provides 24/7 personalized care and support from pharmacists and nurses trained in these conditions. They offer free delivery of the medications, along with special handling such as refrigeration. It’s not clear what the co-pay will be for the delivery.
If you get specialty drugs at one of the affected pharmacies and want to switch to Accredo to fill your prescription for these drugs, call 1-877-882-3324. You can also go to the Accredo website.
Karen has covered military families, quality of life and consumer issues for Military Times for more than 30 years, and is co-author of a chapter on media coverage of military families in the book "A Battle Plan for Supporting Military Families." She previously worked for newspapers in Guam, Norfolk, Jacksonville, Fla., and Athens, Ga.