Veterans could be in for a surprise when they try filling a prescription at the local drug store on Monday.
Starting then, the outfit that administers the Tricare Pharmacy Benefit Program for active and retired Veterans is shrinking its nationwide drug store network by 15,000 stores or 30%, according to the National Community Pharmacists Association, an Alexandria, Va.-based trade group that is fighting the cut.
Express Scripts Inc. is the St. Louis, Missouri-based pharmacy benefit giant that administers the prescription program for Tricare members. In August, it was awarded a $4.3 billion Department of Defense contract to run the program.
The pharmacists association estimated that some 400,000 or about 4% of Tricare’s 9.7 million pharmacy benefit beneficiaries will be affected.
The cut by Express Scripts angered some pharmacists and Veterans, even though the company promised that more than 90% of beneficiaries will have an in-network drugstore within a 15-minute drive of their home after the downsizing.
“The families defending our country are being pushed through a system of greed and profiteering,” said Chris Antypas, president and CEO of Asti’s South Hills Pharmacy in Castle Shannon. “These are people we’ve taken care of forever. It’s hard to walk away from that. It’s an absolute disaster.”
A preferred pharmacy network increases the margin for payers by creating consumer incentives to shop where payer costs are lowest.
In a statement Thursday, Express Scripts said the company would help beneficiaries find an in-network pharmacy, which will include 41,000 chain, grocery and independent drugstores. Giant Eagle, Rite Aid, CVS Health, and Walgreens are among the local pharmacies that will be in-network for Tricare. Walmart will not.
The company declined to confirm the number of stores that would go out of network on Monday, but even some drugstores that remain on the in-network list may disappear soon.
CVS Health announced last year that it was closing about 900 of its retail pharmacies in the U.S. Adam Fein, CEO of Philadelphia-based consultant Drug Channels Institute, blamed the closings on increased competition, expanded prescription of low-margin generic drugs and other factors.
Locally, the number of Veterans who will be affected by the Express Scripts decision was difficult to pin down.
There were 745,909 civilian Veterans in Pennsylvania in 2018, according to the U.S. Census. That includes between 7.6% and 10.1% of the populations of Allegheny and the six surrounding counties. But not all Veterans have Tricare pharmacy benefits and not all will be affected by the smaller network.
Still, one group worried about access to medicines as the result of the downsizing.
“The cut to the Tricare pharmacy network is unprecedented and shortsighted” and it “will likely create insurmountable barriers to accessing essential medications for many beneficiaries,” the Military Officers Association of America, an Alexandria, Va.-based advocacy group wrote in an Oct. 19 editorial.
Like other community pharmacists, Erich Cushey, owner of three Curtis Pharmacy stores in Washington and Fayette counties, said he refused to sign a new contract with Express Scripts, which set the reimbursement he would receive for filling Tricare prescriptions. The payments were below his cost for the medicines, he said.
“It was a take-it-or-leave-it contract,” said Mr. Cushey, whose staff has administered COVID-19 vaccines to Veterans in addition to filling their prescriptions. “We can’t afford to sign that contract. We should be helping Veterans wherever they choose to get prescriptions.”
Asti’s South Hills Pharmacy’s Mr. Antypas said his losses on filling Tricare prescriptions in the new contract would range between $10 and $100 or more, depending on the price of the drug.
Express Scripts runs its own mail-order pharmacy in addition to serving as a pharmacy benefit manager, so a loss of customer from a small drugstore is a likely gain for the bigger company, he said.
“They want us to disappear because if we disappear, those prescriptions go to them,” he said.
What’s different between the local pharmacy and mail-order prescriptions from Express Scripts is service and a human face, said John Stavovy, who retired after 32 years in the military and co-founded Washington, Pa.-based home builder Mesa Wood Ltd. Mr. Stavovy, 74, said he’s had problems with Express Scripts’ mail order system.
“They mess up everything,” he said. “It’s all online, you can’t talk to anybody. They’re just very difficult to work with.”
In a prepared statement, Express Scripts spokesman Meaghan MacDonald said the company couldn’t speak to Mr. Stavovy’s experience, but its pharmacy fills about 100 million prescriptions a year, with 99% accuracy and “consistently high levels of patient satisfaction.”
At Curtis Pharmacy in Washington, three miles from Mr. Stavovy’s home, he said his questions are answered promptly and prescriptions are filled without a hitch. Curtis will be out of his network of providers on Monday.
“I call and they’ll give me the owner,” Mr. Stavovy said. “They’re so nice down there. Curtis Pharmacy is really a hometown thing.”
Mr. Stavovy said he hadn’t yet figured out the location of the nearest in-network Express Scripts pharmacy.
{jcomments on}