Is your pharmacy one of the 15,000 leaving the Tricare network?

Just days before 15,000 community and independent pharmacies leave the Tricare retail pharmacy network, questions remain about the impact on patients’ ability to obtain their medicines.

Other changes, coming with the new year, will affect those who depend on specialist drugs for complex chronic conditions such as cancer, rheumatoid arthritis, multiple sclerosis and other illnesses.

On Monday, Tricare and Express Scripts will reduce the pharmacy network, affecting about 400,000 Tricare beneficiaries, according to the National Community Pharmacists Association. Of the approximately 55,586 retail pharmacies in the Tricare network, 14,963 will leave after refusing to agree to reimbursement terms and other conditions.

These pharmacies will now be out-of-network, and recipients who continue to use them will pay full drug prices and then seek reimbursement, which is subject to the deductible as well as a higher out-of-network cost share, US said. Public Health Service Cmdr. Teisha Robertson during a Tricare Pharmacy webinar on October 20. Robertson herself is a pharmacist in the Pharmaceutical Operations Division of the Defense Health Agency.

The loss of these nearly 15,000 network pharmacies sounded the alarm.

“I live in a rural area and Express Scripts overrides network status [of] local pharmacies, which in some cases means a patient would have to travel more than 50 miles to access an in-network pharmacy,” wrote a Minot, North Dakota, pharmacist on a petition started by the Georgia Pharmacy Association .

“It does NOT benefit the patient – especially with high gas prices and having to drive two hours round trip to fill a prescription.”

The petition had garnered 3,614 signatures as of October 21.

Lawmakers have written to Secretary of Defense Lloyd Austin expressing their concerns, as have several pharmacy associations.

“Tricare patients have earned their benefits, and it is imperative that they maintain convenient access to their health care providers,” wrote B. Douglas Hoey, executive director of the National Community Pharmacists Association, in a letter from the October 18 in Austin.

“With the vast majority of independent pharmacies out of the network…it’s hard to see how Cigna/Express Scripts meets even the reduced access standards in its new contract with the DoD,” Hoey wrote. “We therefore urge you to take steps to ensure that all pharmacies that were included in the 2022 Tricare network remain in the 2023 network on the 2022 terms and conditions.

“Without this action, access to needed medicines for Tricare beneficiaries is at risk.”

No response has been received from the Ministry of Defence, a spokeswoman said.

Despite the change, “the Tricare retail network will continue to meet or exceed Tricare’s standard for access to pharmacies,” Defense Health Agency spokesman Peter Graves told the Military Times earlier. . CVS and Walgreens, as well as many grocery drugstores, wholesale warehouse stores and small chains, including some independent neighborhood pharmacies, continue to participate.

“Nearly 95% of beneficiaries will maintain access to at least two network pharmacies within 15 minutes of their home, and 99.8% will have access within 30 minutes,” he said.

In mid-September, Express Scripts sent a letter notifying affected beneficiaries of the change. The letter contained a list of other nearby network pharmacies. As of October 24, beneficiaries can also use the Find a Pharmacy tool to find retail network pharmacies in their area. This online search tool will be updated by Express Scripts once network changes go live, officials said.

For those who have a prescription at one of the pharmacies leaving the network and wish to transfer it to a new pharmacy in the retail network, officials advise three different ways to move those prescriptions:

  • Bring your medicine bottles to another pharmacy in the participating network. The pharmacy will inform you of their process.
  • Call your doctor’s office. Ask them to send your prescription to your new network pharmacy.
  • Call your new network pharmacy and ask them to transfer your prescription.

Other options include using the Tricare Pharmacy home delivery program or a military pharmacy. At military pharmacies, you can get up to 90 days’ supply of most covered medications free of charge.

There is a co-payment required for those using door-to-door delivery or going to any pharmacy in the retail network. Visit the Tricare Costs page to see pharmacy co-pays for your health plan.

Changes for specialty drug prescriptions

As of January 1, Accredo will be the main specialty pharmacy in the Tricare network, and beneficiaries must obtain their specialty medications from a pharmacy in the network.

Until this change, prescriptions for these specialty drugs for complex chronic conditions such as cancer, multiple sclerosis, rheumatoid arthritis and hepatitis C were filled in a variety of locations, including a number of retail pharmacies. individually, and through Express Scripts mail order. pharmacy.

It is unclear whether those who have their specialty medications filled at one of the pharmacies leaving the Tricare pharmacy network on Monday will have wiggle room to be able to continue getting their prescriptions until January 1, but the Accredo service is already available for those who want to change before January 1st.

It is expected that Accredo will fulfill almost all of these specialized requirements and save the Department of Defense money.

“We don’t object to these measures to save money as long as people can still access their benefits,” said Karen Ruedisueli, government relations director for health affairs at the Military Officers Association of America. “There are questions about whether the most vulnerable people will be able to access their benefits.”

Specialty drugs are usually expensive, self-administered oral or injectable medications. They may require clinical training to administer; they may require special storage and handling; and are not available at many retail pharmacies.

Express Scripts is the parent company of Accredo Health Group, and Cigna and Express Scripts merged several years ago.

According to Accredo’s website, it provides 24/7 personalized care and support from trained pharmacists and nurses. They offer free delivery of medications, as well as special handling such as refrigeration. It is not known what the co-payment for delivery will be.

If you get specialty medications from one of the affected pharmacies and would like to switch to Accredo to fill your prescription for these medications, call 1-877-882-3324. You can also go to the Accredo site.

Karen has covered military families, quality of life and consumer issues for Military Times for over 30 years, and co-authored a chapter on media coverage of military families in the book “A Battle Plan for Supporting Military Families”. She previously worked for newspapers in Guam, Norfolk, Jacksonville, Florida and Athens, Georgia.

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