Military Veterans Deserve Uninterrupted Pharmacy Access

DATE: October 14, 2022

Military Retirees Will Lose Long-Term Care Pharmacy Services as soon as Oct. 24, 2022

TRICARE and its Pharmacy Benefit: The TRICARE program, operated by the Department of Defense (Defense Health Agency), covers 9.6 million active-duty service members and their family members, along with military retirees, many of whom live in long-term care (LTC) facilities like nursing homes and assisted living communities.

While TRICARE does not cover LTC services, it does cover prescription drugs for beneficiaries living in LTC facilities. Individuals living in these facilities require specialized pharmacy services beyond those provided by retail or mail order pharmacies, and pharmacies are legally to provide these services in nursing homes.

The Problem: Express Scripts (ESI) contracts with TRICARE as the pharmacy benefits manager (PBM) administering the TRICARE prescription drug benefit. In July 2022, ESI notified some independent retail and LTC pharmacies in the TRICARE network that, effective January 1, 2023, contractual terms with TRICARE would change such that pharmacies would lose money serving TRICARE beneficiaries. ESI intended to slash payments to acquire drugs and pay nothing to pharmacies for dispensing medications. ESI demanded that pharmacies accept the new terms in writing within 14 days or be expelled from its network. ESI did not offer the new contract to many current network pharmacies, but simply kicked them out of the network.

It appears that ESI intends to significantly limit the TRICARE pharmacy network so that ESI’s own mail order pharmacy will corner the market on TRICARE pharmacy business. On September 1, 2022, ESI sent notices to TRICARE beneficiaries notifying them that their existing pharmacy was no longer in network, and that they would have to now obtain their drugs from either ESI’s mail order pharmacy or a local retail pharmacy, while simultaneously limiting the in-network retail pharmacies.

This has created confusion for military members, their families, and military retirees. The situation was made worse because ESI notified beneficiaries that their pharmacies had left the TRICARE network voluntarily and provided inaccurate information concerning alternative pharmacies available to beneficiaries. In addition, ESI simply did not acknowledge that beneficiaries living in LTC facilities would be unable to obtain needed services from pharmacies remaining in the network. Residents in LTC facilities require not only drugs but also related specialized services that LTC pharmacies provide – and are required to provide by law. Mail order and retail pharmacies simply do not provide these services.

While both TRICARE plans for beneficiaries and TRICARE contracts with pharmacies are calendar-year agreements, ESI has informed these beneficiaries that they will lose access to their current pharmacies on October 24, 2022. ESI’s mail order pharmacy does not provide the pharmacy services or supplies needed for beneficiaries who live in LTC facilities or require home infusion, putting their access to essential drugs and services, as well as their quality of care, at substantial risk.

The Solution: While more than 100 members of Congress have submitted letters to the DoD demanding explanations, more needs to be done, now. Beneficiaries will lose access as soon as October 24. Congress should compel TRICARE to keep its 2022 network intact for 2023, assure that the terms and conditions of the 2022 contract remain in effect in 2023, and prevent TRICARE from allowing the PBM with which it contracts to steer TRICARE business to pharmacies that are part of the same corporate family as the PBM.

Urge TRICARE to reinstate military access to existing pharmacies, including LTC pharmacies, now.