In a June 26 letter to the director of the Defense Health Agency and the assistant secretary of defense for health affairs, lawmakers alleged Express Scripts has “leveraged its market power to squeeze independent pharmacies and steer Tricare beneficiaries to their own mail-order pharmacy.”
Express Scripts, Cigna’s pharmaceutical benefit manager, has managed pharmaceutical benefits for Tricare, which provides coverage to military members and their families, since 2009. Cigna acquired Express Scripts in 2018.
In late 2022, thousands of pharmacies left Express Scripts’ Tricare network. Pharmacies said the reimbursement rates offered by the pharmaceutical benefit manager were too low. In their letter, the lawmakers alleged a lack of pharmacies in network drove beneficiaries to use Cigna’s mail-order pharmacy, Accredo.
“This exodus of independent and retail pharmacies can be catastrophic for Tricare beneficiaries, especially those with complex medical conditions who are ill-served by mail-order pharmacies,” the lawmakers wrote.
The lawmakers also expressed concern that the government could be overpaying for drugs dispensed by Express Scripts. In their letter, the lawmakers cited a Wall Street Journal investigation that found that Express Scripts charged insurers 27.4 times more for drugs than Cost Plus Drugs Co.
In a statement shared with Becker’s, an Express Scripts spokesperson said the company has achieved billions in savings for the government and taxpayers.
“Tricare beneficiaries have access to the full range of generic, brand and specialty medications on the market today through our robust network of chain, independent, military, specialty and home delivery pharmacies,” the spokesperson said. “Beneficiaries are not required to fill the majority of specialty prescriptions through Accredo, though many choose to because of the highly personalized support they receive from their pharmacists, nurses, clinicians, dieticians and social workers.”
Lawmakers asked the Defense Health Agency to provide information on its pharmacy network and the prices Express Scripts charges.
Read the full letter here.
