The company that manages Tricare's pharmacy benefits will give thousands of independent and community pharmacies that left the network last month an opportunity to rejoin -- but it's unclear whether the terms of the contract will be any different than those that caused them to leave in the first place.
At the end of last week, Express Scripts started informing pharmacies that it will send out another contract solicitation in December. If the pharmacies accept the contract, they will be back in Tricare's network on Jan. 15.
The move could mean some of the 14,963 retail pharmacies that left the network in October will come back. But advocates for those pharmacies were pessimistic the contract would prove more favorable this time around.
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Despite the outcry from veterans, advocates and members of Congress over the independent pharmacies that left, Express Scripts said the main impetus for reoffering a contract was supermarket giant Kroger's recent announcement that it will end its deal with the pharmacy benefits manager at the end of the year unless a more "equitable" agreement is offered.
"We constantly evaluate ways to improve access and choice for those we serve, so as a result of Kroger's recent notice that they will no longer participate in the Tricare pharmacy network, independent pharmacies that declined our previous invitation will be given another chance to consider participating," Tom Jenkins, Express Scripts vice president of account management for DoD Programs, said in a written statement.
The independent pharmacies were dropped from the network Oct. 24. Many declined the contract to stay on because of lowered reimbursement rates they said would mean they had to operate at a loss. But they were also blindsided by the Oct. 24 date, thinking they would stay on the network until the end of the year. Other pharmacies were unaware their wholesaler or agency that represents them in negotiations had declined the contract on their behalf.
When asked whether the new contracts would be the same as those previously rejected by some independent pharmacies, Express Scripts Spokesperson Justine Sessions declined to comment.
Ronna Hauser, senior vice president of policy and pharmacy affairs at the National Community Pharmacists Association, which is advocating on behalf of the independent pharmacies, said that while the organization does not definitively know the terms of the upcoming contract, early indications are that it will be the same as the previous one.
"I don't have a crystal ball as to what's going to happen, but this may be just an exact replay of the unfortunate situation we saw before, where independent pharmacies will still not be able to participate in the network," Hauser said. "I've had members use the terms 'dog and pony show,' 'smoke and mirrors,' 'Groundhog Day.'"
The move by Kroger to leave Express Scripts vindicates the independent pharmacies' stance, Hauser argued.
"It was not our members choosing to leave this network, it was our members being forced to leave this network as business owners," she said.
Rep. Buddy Carter, R-Ga., who has been asking Tricare patients to contact him if they were affected by the pharmacy reductions, was similarly unsatisfied with Express Scripts' announcement.
"This is an empty gesture, and the facts remain the same: Tricare beneficiaries are losing access to their local pharmacy to pad Express Scripts' bottom line," Carter said in an emailed statement to Military.com. "The DoD must step in and rectify this situation so that patients, not pharmacy benefit managers, are put first."
But the Express Scripts officials said they're hopeful at least some pharmacies will come back, in part because they are doing more outreach directly to the pharmacies represented by a wholesaler so that those stores can in turn push their representatives to accept the contract.
The officials also pointed to feedback from members of Congress as one of the reasons they are inviting pharmacies to rejoin the network.
Once the solicitation is out, pharmacies will have 15 days to accept or reject the contract, the officials said.
"Even without Kroger's participation, nearly all Tricare beneficiaries have an in-network pharmacy within a 15-minute drive of their home, but we are always working to provide more choice to our members and look forward to welcoming additional independent pharmacies back into the network," Jenkins said in his statement.
The Military Officers Association of America, which has also expressed concern about the pharmacies being dropped from Tricare, appeared more optimistic about the latest development.
"The Military Officers Association of America has received significant member feedback describing longer drives, problems involving medication at long-term care facilities, and a host of other issues," Karen Ruedisueli, MOAA's director of government relations for health affairs, said in a written statement. "MOAA supports any work to reestablish a strong retail network to ensure beneficiaries can access their service-earned benefits."
-- Rebecca Kheel can be reached at rebecca.kheel@military.com. Follow her on Twitter @reporterkheel.
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