Introduction
A group of 24 lawmakers has raised significant concerns regarding Express Scripts‘ management of the Tricare pharmacy network, alleging anti-competitive practices that limit Tricare beneficiaries’ choice of pharmacies. This article delves into the details of these allegations, their implications for Tricare beneficiaries, and the responses from Express Scripts.
Background on Express Scripts and Tricare
Express Scripts, a pharmaceutical benefit manager acquired by Cigna in 2018, has been managing pharmaceutical benefits for Tricare since 2009. Tricare provides health coverage to military members and their families, ensuring they have access to necessary medications through a network of pharmacies.
Lawmakers’ Allegations
Pharmacy Choice Limitation
In a letter dated June 26, addressed to the director of the Defense Health Agency and the assistant secretary of defense for health affairs, lawmakers expressed concerns that Express Scripts may be leveraging its market power to limit Tricare beneficiaries’ choice of pharmacies. They alleged that the company is steering beneficiaries toward its own mail-order pharmacy, Accredo, by squeezing independent pharmacies out of the network.
Market Power Abuse
The lawmakers highlighted that Express Scripts’ reimbursement rates to pharmacies were too low, leading to thousands of pharmacies exiting the Tricare network in late 2022. This reduction in network pharmacies has allegedly driven beneficiaries to use Cigna’s mail-order pharmacy, limiting their options and potentially impacting the quality of care.
Impact on Tricare Beneficiaries
Effects on Independent Pharmacies
The lawmakers’ letter emphasized that the departure of independent and retail pharmacies from the Tricare network could be catastrophic, particularly for beneficiaries with complex medical conditions who might not be well-served by mail-order pharmacies. Reducing pharmacy options could force beneficiaries to rely on less personalized mail-order services, which may not meet their specific medical needs.
Consequences for Beneficiaries with Complex Conditions
Access to local pharmacies is crucial for Tricare beneficiaries with complex medical conditions. These individuals often require personalized care and immediate access to medications, which mail-order services may not adequately provide. The lawmakers’ concerns suggest that the shift to mail-order pharmacies could negatively affect these vulnerable populations.
Financial Implications
Overpayment Concerns
Another major concern raised by the lawmakers is the potential overpayment for drugs dispensed by Express Scripts. They cited a Wall Street Journal investigation that found Express Scripts charged insurers significantly more for drugs compared to Cost Plus Drugs Co. The lawmakers fear that the government and taxpayers may be overpaying for medications, resulting in unnecessary expenditure.
Cost Comparisons
The Wall Street Journal investigation revealed that Express Scripts charged insurers 27.4 times more for drugs than Cost Plus Drugs Co. This stark difference in pricing raises questions about the cost-effectiveness of Express Scripts’ services and whether they are providing value for the money spent by the government and taxpayers.
Express Scripts’ Defense
Cost Savings Claims
In response to the allegations, an Express Scripts spokesperson shared a statement with Becker’s, asserting that the company has achieved billions in savings for the government and taxpayers. They emphasized that Tricare beneficiaries have access to a comprehensive range of generic, brand, and specialty medications through a robust network of chain, independent, military, specialty, and home delivery pharmacies.
Access to Medications
Express Scripts also defended its practices by stating that beneficiaries are not required to fill the majority of specialty prescriptions through Accredo. Instead, many choose to do so because of the personalized support they receive from pharmacists, nurses, clinicians, dietitians, and social workers. This personalized support, according to Express Scripts, enhances the quality of care and convenience for beneficiaries.
Conclusion
The allegations against Express Scripts (ES) regarding their management of the Tricare pharmacy network have sparked significant concern among lawmakers. The potential limitation of pharmacy choices and the financial implications for the government and taxpayers are critical issues that need thorough investigation. While ES defends its practices by highlighting cost savings and access to medications, the impact on Tricare beneficiaries, especially those with complex conditions, remains a pressing concern.
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FAQs
Q: What are the main allegations against Express Scripts?
A: Lawmakers allege that Express Scripts is limiting Tricare beneficiaries’ choice of pharmacies and steering them towards its own mail-order pharmacy, Accredo, by squeezing independent pharmacies out of the network.
Q: What are the financial concerns raised by the lawmakers?
A: Lawmakers are concerned that the government may be overpaying for drugs dispensed by Express Scripts, as evidenced by a Wall Street Journal investigation showing significantly higher charges compared to Cost Plus Drugs Co.
Q: How might these allegations affect Tricare beneficiaries?
A: The alleged limitation of pharmacy choices could be particularly detrimental to beneficiaries with complex medical conditions who may not be well-served by mail-order pharmacies.
