Tricare, the U.S. military’s health care provider, has renewed a contract with the PBM Express Scripts Inc. to manage its pharmacy benefits, and lawmakers are concerned. ESI has already cut thousands of independent pharmacies out of the network and unsustainably low reimbursement rates are still driving them away from Tricare, reporting from Roll Call shows.
The PBM’s unfair rates are attracting scrutiny by members of Congress, who are now asking for more information on beneficiary access to pharmacies under Tricare.
ESI recently ended negotiations with a group representing over a thousand independent pharmacies that pushed for increases to reimbursement rates, meaning more pharmacies may have to leave the network.
Steve Moore, owner of Condo Pharmacy in Plattsburgh, N.Y. and member of the NCPA Board of Directors, was interviewed for the article and said he would be out of network with Tricare later this month. “Every attempt to negotiate with ESI is met with the same canned response about ‘best and final’ rates,” Moore wrote to the PBM in response to one of its offers. “I am incredibly disappointed in how ESI has handled this ‘negotiation’ and it is ultimately our patients who will lose out.”
