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TRICARE pharmacy decision upsets independent owners, congressmen

By MARY SELL, Alabama Daily News

MONTGOMERY, Ala. – Alabama military members, veterans and their families may have fewer pharmacy options this week after TRICARE shrunk its list of in-network pharmacies by about 15,000 independent operators nationwide.

The decision by TRICARE, a U.S. Department of Defense health care program, and its pharmacy benefits manager, Express Scripts, has drawn criticism from independent pharmacists and Congressmen in Alabama.

“I have previously expressed my concern to the Department of Defense regarding TRICARE’s pharmacy changes,” Congressman Mike Rogers, R-Saks, told Alabama Daily News. He’s the ranking member of the House Armed Services Committee. “I am seeking answers from the department on how these changes were made and how TRICARE beneficiaries can maintain access to local pharmacies.”

TRICARE, in a press release this month, said 40,000 pharmacies remain in the network. 

“The Defense Health Agency is confident that the new pharmacy contract maintains the quality of the TRICARE retail pharmacy network,” said Edward Norton, Jr., chief of the Pharmacy Operations Division at the Defense Health Agency.

According to TRICARE, more than 90% of beneficiaries will have at least one network pharmacy within 15 minutes of their home. Many of them are chain stores.

Bobby Giles, government affairs director for the Alabama Pharmacy Association, said local pharmacies have been barely breaking even on the prescriptions they fill under TRICARE for years and couldn’t accept the terms of a new contract proposed by Express Scripts. He also said Express Scripts is trying to move its customers toward mail-order for long-term prescriptions.

“Alabama Pharmacy Association member pharmacists are being prohibited from taking care of the military personnel and their families that we’ve taken care of for years,” Giles told Alabama Daily News. “The pharmacists are not choosing not to serve those families that have served us. We’re being forced out by Express Scripts, TRICARE’s (pharmacy benefits manager). 

Giles said member pharmacies can’t operate at a loss.

“The contract offered is not paying the acquisition cost of the drug ingredients being dispensed, much less at the pharmacy business overhead,” Giles said.

Giles said there are more than 550 independent retail pharmacies in the state. It was unclear how many were no longer in the TRICARE network following Monday’s change. According to TRICARE, Express Scripts last month sent a letter to affected customers notifying them of the change.

While they were breaking even on TRICARE prescriptions, Giles said locally owned pharmacies do get revenue from military customers through other services they provide and retail items they sell.

There are about 400,000 veterans in Alabama, according to the Alabama Department of Veterans Affairs.

Congressman Jerry Carl, R-Mobile, told Alabama Daily News that he and others in the Alabama delegation, as well as those from other states, are seeking more information on that change. Meanwhile he’s hearing from upset constituents.

Carl compared this pharmacy situation to the baby formula shortages earlier this year in that a few major suppliers took over the market, but when they had manufacturing problems, “we had shelves that were empty.”

“I’m afraid we’re going to do the same thing with the pharmacy field,” Carl said. “We’re trying to get it cheaper and cheaper, and we can appreciate that as taxpayers, but our local pharmacists that are being cut out of this are extremely important in our lives and it’s going to affect them the most.”

He said he doesn’t want to see local pharmacies close and then the larger national chains hit a “bump” and not be available to provide.

The Alabama-based American Pharmacy Cooperative, Inc. also spoke against the change, saying military members and veterans deserve better than the change that was forced on them.

“American Pharmacy Cooperative, Inc., is disheartened by these changes to TRICARE’s prescription drug benefit and will continue to press for broad access to the pharmacy of choice for all TRICARE beneficiaries,” the group said in a written statement to Alabama Daily News.

Meanwhile, Giles said the TRICARE decision is a “horrible precedent.” If military members and veterans can be kept from using local pharmacies, others could be in the future, he said. 

Alabama Daily News Publisher Todd Stacy contributed to this report. 


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