The Government Accountability Office issued a report calling for the increased monitoring of Express Scripts Inc.'s role as the pharmacy benefits manager of Tricare. The report concluded that while the Department of Defense's Defense Health Agency monitors certain aspects of beneficiary access to pharmacy services, it needs to strengthen its monitoring of ESI.
GAO's review found that the DHA is not monitoring ESI's timeliness in dispensing mail-order specialty drugs, nor is it verifying the accuracy of data that ESI relies on to ensure beneficiary access to pharmacy services, as required by its Quality Assurance Surveillance Plan. The report states that by addressing these gaps in its monitoring of beneficiary access—particularly as it relates to key changes implemented—DHA can better ensure that it is meeting the goals of its program and providing beneficiaries access to the prescription drugs they need. GAO also stated that enhanced monitoring could assist DHA in determining whether performance standards to ensure beneficiary access are needed and how to establish them.
GAO issued the following recommendations to DHA:
1. The director of the Defense Health Agency should monitor ESI's timeliness in dispensing mail-order specialty drugs; and
2. The director of the Defense Health Agency should periodically audit Tricare pharmacy program data that ESI reports for accuracy, as required by DHA's Quality Assurance Surveillance Plan.
