By MOAA Staff
With about 13,000 community pharmacies removed from the TRICARE Retail Pharmacy network, and thousands more leaving after the departure of a nationwide grocery chain, about 400,000 beneficiaries must find a new location to fill their prescriptions if they want to receive the full value of their earned benefit.
And while DoD officials claim the program will “meet or exceed” access-to-care standards after the reduction in community care and the departure of 2,200 Kroger locations, some of the beneficiaries affected would take significant issue with that claim.
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MOAA has heard from hundreds of these individuals, with complaints ranging from longer drives to availability concerns to a significant financial burden caused by a pharmacy’s departure from the network. This is an acute problem for long-term care (LTC) residents, many of whom don’t have an option to switch drug providers if their LTC facility contracts with a local pharmacy.
MOAA has met with both Express Scripts (ESI) and the Defense Health Agency (DHA) to give them an opportunity to address our concerns. Express Scripts has now given independent pharmacies the opportunity to rejoin, but it is unclear whether the contract terms will be modified with more favorable reimbursements.
DoD reports as of Dec. 8 approximately 2,000 independent pharmacies have elected to rejoin the TRICARE network, out of the 14,963 that left in October. Pharmacies electing to join the TPharm5 retail pharmacy network will be added back no later than Jan. 15, 2023.
MOAA also took the issue directly to lawmakers. Sen. James Lankford (R-Okla.) introduced an amendment to the Senate version of the FY 2023 National Defense Authorization Act (NDAA), but with little time to build awareness and support, it was not included in the Senate NDAA manager’s package.
MOAA continues outreach to lawmakers and is working with a congressional office on a potential listening session where DHA and members of Congress will hear directly from military families impacted by pharmacy network cuts. Other offices are drafting letters and requesting meetings with Express Scripts and DHA.
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Kroger’s departure from the TRICARE network is the latest cut to the pharmacy benefit, and it may get even worse if Kroger’s planned merger with Albertsons takes place. Albertsons Companies operate 1,720 grocery store-based pharmacies – if they follow Kroger and sever ties with Express Scripts, TRICARE beneficiaries would lose access to pharmacies at Albertsons stores including Safeway, Jewel-Osco, Vons, Shaws, Tom Thumb, and Randall’s, among others.
The TRICARE Pharmacy network will continue to be a top priority for MOAA in the 118th Congress. It will require a multifaceted effort, directed at both DHA and Congress, to convince them the narrowed pharmacy network is not only an unacceptable cut to the TRICARE benefit – earned through a lifetime of service and sacrifice – but also a threat to recruiting and retaining the all-volunteer force.
‘A Great Concern for Us’
Now that her husband’s VA nursing home pharmacy is cut from the TRICARE network, Sallie Peterson will have to pay "approximately $1,500 per month" for her husband’s prescriptions upfront before being partially reimbursed by the Express Scripts program. Since this spring, Maj. Robert Peterson, USAF (Ret), has been living in a nursing home three hours away from his North Charleston, S.C., home due to complications from Parkinson’s disease and diabetes.
According to the facility’s rules, patients do not have a choice in selecting a pharmacy. Because the facility’s pharmacy is no longer in-network, Sallie will have to pay the full retail price for those drugs. Even after Express Scripts partially reimburses the Petersons, Sallie will still be paying more than when the pharmacy was in-network.
These higher prescription costs come as Sallie spends more on travel expenses and pays to rent an apartment in the area close to the facility.
“He is a retired officer, and at present I have the resources to provide for his continued care and his medications in a truly wonderful and unique skilled nursing facility,” Sallie said. “[However], depending on how long he is able to survive, it may become a great concern for us.”
[RELATED: MOAA’s TRICARE Toolkit]
Lt. Col. Daniel Joyce, USAF (Ret), recently had to place his wife, Fern, in a nursing home memory care unit in Blacksburg, Va.
The local drug store providing medication to the facility was cut from the network; Daniel is paying $40 to $50 more a month for his wife’s medications. The Salem resident feels fortunate he can afford the added expense.
Daniel will continue to rely on the nursing home instead of picking up the medicine himself from an in-network pharmacy to avoid “extra trips here and there and trying to keep track of things.”
Challenges to Access
Long-term care patients aren’t the only beneficiaries facing uncertainty after the Oct. 24 network cuts. Beneficiaries in rural areas replied to MOAA’s request for feedback on the issue, many echoing common themes:
- Concerns over longer trips to in-network chain pharmacies, often made worse by the departure of Walmart from the network last year.
- Disappointment at the end of the personalized service offered by many community locations, including some with free delivery options and easy on-site consultations appealing to older beneficiaries. As one respondent put it, “I have had the same small business pharmacy for many years where I know the pharmacist very well, trust his judgment and he is a confidant like my regular doctor. I am ticked that I will have to go to an anonymous pharmacist in a big store. This is an insult to me and all military retirees.”
- Frustration at the exclusion of pharmacies inside hospitals or attached to medical centers, a move which adds extra travel for beneficiaries and decouples crucial aspects of their follow-on care after surgeries or other significant medical events.
It’s clear the pharmacy cuts make it impossible to “meet or exceed” standards of care for beneficiaries facing the above circumstances. That’s why MOAA has engaged with lawmakers, DHA, and ESI as we work to reverse the cuts and restore this critical benefit to those who need it most.
Grassroots efforts will be critical in reversing this cut. Please watch the weekly MOAA Newsletter for additional calls to action, and keep up with the latest on this and other issues at MOAA’s Advocacy News page. We hope you will also continue your individual outreach to your elected officials – hearing directly from constituents really does make a difference.
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