Dear Colleague,
The semiquincentennial. World Cup Soccer being played in North America. The Fourth of July. Patriotism is crescendoing across the country. Here in D.C., the tents are raised on the National Mall. The Ferris wheel is rotating. The fireworks display to beat all fireworks displays is set to go off in just over a week. Congress is also doing something very patriotic — working to require the taxpayer-funded Tricare pharmacy program to subject itself to an audit so it and taxpayers can know how our tax dollars are being used.
Earlier this month, the Senate Armed Services Committee included a measure to audit Tricare's pharmacy benefit program in its long markup of the FY27 National Defense Authorization Act. The amendment, which was one of NCPA's main priorities during the annual Congressional Pharmacy Fly-In, was offered by Sen. Elizabeth Warren (D-Mass.). It requires an annual audit done by the Government Accountability Office of the Tricare pharmacy benefits program, examining reimbursement rates, prior authorizations, dispensing timeliness, and pharmacy network adequacy. This closely mirrors the language in the House version of the NDAA they passed on June 4.
Express Scripts Inc. has held the contract for Tricare's pharmacy benefit since 2009, and an audit is sorely needed.
To the casual observer, this would seem like a no-brainer. An audit of a contract worth over $5 billion of taxpayer money that has been repeatedly awarded to the same contractor for over 17 years seems like an obvious and prudent move to make sure the U.S. and our veterans are getting the best deal possible — especially to a contractor that, in a 2024 audit by the Office of Inspector General, was found to have overcharged U.S. Postal Service employees by $44.9 million just two years ago.
But has an audit ever been conducted? Not that we or Congress know of. Congress has been asking for more accountability for years, but the Defense Health Agency has been reluctant to provide the level of transparency that would answer straightforward questions, like how much ESI pays itself for each mail-order prescription.
It's ironic that the Senate Armed Services Committee is privy to highly classified information, even including things like nuclear submarines, advanced weapons programs, and military readiness, but they can't get the answer to how much a mail-order pharmacy charges taxpayers to distribute a prescription.
Speaking of patriotism, being able to serve our veterans is a hot-button issue for independent pharmacy owners. Many were booted out of or had no choice but to leave the Tricare pharmacy network due to prescription drug reimbursements that were less than the cost for them to buy the medication. They are proud of our country and the men and women of our military who have fought for our freedom. Being forced to go out of business to serve the people who served our country does not sit well. An audit to find out how much their competitor is paying itself to do services that local businesses can do just as well and better seems like it should be a small ask.
Wouldn't it be fitting if, in the same year of celebrating 250 years of freedom for all, taxpayers, veterans, and small business owners also got to celebrate the information about how much the DHA is spending for each mail-order prescription finally being liberated?
Best,
B. Douglas Hoey, Pharmacist, MBA
NCPA CEO
P.S. Speaking of service, NCPA wants to know how we are doing and how we can even better serve independent pharmacy owners. Click here to take this short survey.
