Change to Military Pharmacy Contract is De Facto Exclusion of 15,000+ Independent Pharmacies by PBM Giant Express Scripts

WASHINGTON, D.C., UNITED STATES, October 24, 2022 /EINPresswire.com/ -- Concerned that active military, veterans, and their families have lost access to care from the pharmacy providers of their choice, the Community Oncology Alliance (COA) submitted a letter to the Defense Health Agency (DHA) and Congress last week expressing outrage at recent changes that have effectively removed 15,000+ independent pharmacies from the TRICARE Pharmacy Benefits Program. For those battling cancer, this change is forcing them to use an unreliable and wasteful mail order pharmacy owned by the pharmacy benefit manager (PBM) contracted by TRICARE.

Tricare is the Department of Defense (DoD) health care program for approximately 9.5 million military and their families. It is administered by the DHA by means of the Military Health System. Earlier this year, the PBM Express Scripts was awarded a multi-year contract to serve as the sole PBM to administer the pharmacy benefit offered to TRICARE beneficiaries. Starting today, TRICARE is forcing patients with cancer and other serious diseases to use its Accredo Health, a mail-order pharmacy company owned by Express Scripts’ parent company, Cigna.

- Click here to read COA’s full letter to TRICARE.

To participate in the TRICARE Pharmacy Benefits Program, providers must have a contract with Express Scripts. The 2023 contract offered unreasonably low rates that would have forced providers serving TRICARE patients to operate at a guaranteed loss. This has essentially served as a de facto termination of providers from the TRICARE network, including a substantial percentage of community oncology and urology providers. Of course, Express Scripts is more than happy to fill and profit off this access void with their Accredo mail order facilities.

The forced use of PBM mail order pharmacies leads to expensive prescription waste, access problems, care continuity disruptions, and all too often, unnecessary patient suffering. COA has published countless horror stories of patients with cancer – including several captured in the letter to the DHA – facing delays, higher costs, and denials when subjected to receiving their medications through the mail. Additionally, payers experience higher costs from waste as a lack of coordination between providers and PBMs, resulting in PBMs continuing to mail medications when the drug dosage or even the medication has been changed.

COA has heard from patients, practices, and pharmacies confused about the change and expressing outrage that patients are being forced to choose a pharmacy they do not want while making it harder to receive care. It is vitally important that patients with cancer have easy access to high-quality, integrated care. Requiring the use of mail-order PBM pharmacies exacerbate these problems, as there are well-documented issues with the quality, safety, and timeliness of prescription delivery.

Read COA’s full letter regarding the TRICARE change at https://communityoncology.org/reports-and-publications/comment-letters/letter-to-defense-health-agency-on-tricare-pbm-concerns/.

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About the Community Oncology Alliance: COA is a non-profit organization dedicated to advocating for community oncology practices and, most importantly, the patients they serve. COA is the only organization dedicated solely to community oncology where the majority of Americans with cancer are treated. The mission of COA is to ensure that patients with cancer receive quality, affordable, and accessible cancer care in their own communities. More than 5,000 people in the United States are diagnosed with cancer every day and deaths from the disease have been steadily declining due to earlier detection, diagnosis, and treatment. Learn more at www.CommunityOncology.org. Follow COA on Twitter at www.twitter.com/oncologyCOA or on Facebook at www.facebook.com/CommunityOncologyAlliance.

Drew Lovejoy
Community Oncology Alliance
info@coacancer.org