MOAA is fighting on your behalf to reverse a recently announced cut to the TRICARE Retail Pharmacy network, which will shed approximately 15,000 community pharmacies as of Oct. 24. Nearly 400,000 beneficiaries, or roughly 4% of the TRICARE-eligible population, will be affected by the change.
Beneficiaries who continue to fill prescriptions at departing community pharmacies after Oct. 24 will pay the full retail price for the medication; they must submit a claim to TRICARE for partial reimbursement, which is subject to deductibles and out-of-network cost shares.
[TAKE ACTION: Help MOAA Fight Cuts to the TRICARE Pharmacy Network]
MOAA is working to reverse this cut to your pharmacy benefit. We are most urgently working to address access to prescription medications for impacted long-term care (LTC) residents and beneficiaries in rural areas.
To reduce medication administration errors, most LTC facilities contract with a pharmacy to provide specially packaged prescription drugs. Many of these pharmacies will be removed from the TRICARE network this month; for LTC residents facing such a situation, switching to a retail pharmacy or home delivery may not be an option.
Beneficiaries may continue to use a non-network pharmacy and file claims for reimbursement, but the upfront cost of prescription drugs and the administrative burden associated with filing such claims, will make this an unattractive option for many.
MOAA also is concerned about access to care in rural areas, where beneficiaries lost Walmart pharmacy access just last year. Some MOAA members report they will have to pass a community pharmacy and/or a Walmart on a drive of 20 or 30 miles to reach a network pharmacy.
Share Your Pharmacy Story With MOAA
We want to hear from members whose local pharmacy will leave the TRICARE retail pharmacy network this month – especially those in rural areas with few retail pharmacy choices, as well as long-term care recipients who may have limited or no options to transfer their medications.
Hundreds of members have shared their stories since late September; their stories help inform MOAA’s advocacy efforts. Join their ranks by filling out MOAA's Legislative Action Center engagement form or by emailing email@example.com.
Those who retain access to larger chains still will see a reduction in their benefit, as they lose the ability to visit niche pharmacy locations – inside hospitals, for example, or within medical centers offering post-surgery or inpatient care – and access the personalized services offered by many community pharmacies. These services are especially important to the elderly and support medication adherence.
Many thanks to the hundreds of MOAA members who have shared their perspectives and helped us fully understand the impacts of this TRICARE Pharmacy program cut; you can send us your feedback at this link.
Some community pharmacies report the contract terms offered for continued participation in the TRICARE network were “the worst they’d ever seen,” with prices below cost and no opportunity for negotiation. Others were blindsided by contract terminations or learned about the change from customers who had received letters from Express Scripts.
We realize the Defense Health Program budget is under immense pressure, and as the leading voice on Capitol Hill for controlling TRICARE fees, MOAA has not opposed efforts to control costs as long as beneficiaries maintain access to quality care.
However, this cut to the TRICARE Pharmacy network is unprecedented and shortsighted. It likely will create insurmountable barriers to accessing essential medications for many beneficiaries. These indiscriminate cuts are not only an affront to a lifetime of service and sacrifice, they may actually drive up overall TRICARE spending, as research shows medication non-adherence leads to poor outcomes, increased health care utilization, and overall health care costs.
[RELATED: MOAA's TRICARE Toolkit]
MOAA has met with Express Scripts and the Defense Health Agency and is now taking this issue to Capitol Hill. Please join us by urging your lawmakers to reverse this cut to your earned health care benefit.
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