Guest column submitted by the Idaho Congressional Delegation: Senator Mike Crapo, Senator James E. Risch, Representative Mike Simpson and Representative Russ Fulcher
Idaho is made even greater by the more than 116,000 veterans, the 4,063 active-duty servicemembers and the 8,367 National Guard and reserve members who live here. We have been working steadily to ensure federal policy supports their service and makes it easier for them to live here in Idaho. This includes our raising concerns about a recent change cutting almost 15,000 pharmacies, mostly in small communities, from the TRICARE program, limiting military families’ ability to continue going to their community pharmacies for their prescriptions.
Express Scripts, Inc. (ESI), the pharmacy benefit manager for TRICARE, has implemented pharmacy network changes that disproportionally harm small community pharmacies by cutting the reimbursement rate for prescriptions dispensed in-network. As a result, a number of pharmacies will no longer be able to afford to participate in the TRICARE pharmacy network. ESI made these changes unilaterally, terminating 2022 contracts two months early rather than allowing them to expire at the end of the year.
For example, Sandpoint Super Drug, a local pharmacy that serves the rural community of Sandpoint, has a clientele base that is comprised of roughly 30 percent TRICARE patients. Sandpoint Super Drug was recently notified it will no longer be in the TRICARE pharmacy network because its Pharmacy Service Administrative Organization (PSAO) declined the proposed contract terms for continued participation on its behalf. Scott Porter, Pharmacist and owner of Sandpoint Super Drug said, “I have asked repeatedly for a stand-alone contract with Sandpoint Super Drug and ESI-TRICARE as if my contracting agency never existed. I am losing customers daily because of this agreement with TRICARE-ESI and larger corporate pharmacies. This is preventing me from meeting the prescription needs of many TRICARE recipients in my community.”
We wrote to the U.S. Department of Defense’s Defense Health Agency (DHA) questioning the abrupt changes. Among our many questions about the changes and their impacts, we asked about:
- What steps are being taken to address concerns about TRICARE pharmacy network reductions and access to retail pharmacy services for beneficiaries;
- Recourse available to community pharmacies that wish to continue to participate in TRICARE through stand-alone contracts;
- How many families are impacted by the changes, and if unknown, why there was not an assessment before contract negotiations took place; and may other questions.
Regrettably, too many veterans and servicemembers still face barriers to the care and services they need, and limiting access to critical pharmacy services is deeply concerning. Idaho servicemembers and veterans should be free to go to trusted, local pharmacists to pick up prescription drugs if they choose.
On November 11, 2022, ESI announced it will be reopening negotiations for community pharmacy participation in the TRICARE pharmacy network. We will keep our eyes on this issue as the pharmacy contract negotiations continue, keep pushing for answers about these recent changes affecting TRICARE’s retail pharmacy network and look for remedies that support Idaho’s uniformed servicemembers, veterans and their families, as well as the community pharmacies that serve them.
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