Cigna and its pharmacy benefit manager subsidiary Express Scripts should roll back a decision to shrink by 13,000 the pharmacy network for TRICARE, which offers coverage for active-duty military members, pharmacy groups say.
The groups wrote a letter to Cigna and Express Scripts leadership Tuesday (PDF) surrounding a decision to change the pharmacy network for TRICARE beneficiaries. They were concerned that Cigna decided to end the contracts in late October as opposed to the end of the year, and there is widespread confusion over which pharmacies remain in-network.
“Not only are patients scrambling, but there is a lot of confusion out there,” said Ronna Hauser, senior vice president of policy and pharmacy affairs at the National Community Pharmacists Association, in an interview with Fierce Healthcare. The group is one of several to sign on to the letter.
The groups wrote that Express Scripts sent out contract terms to independent pharmacies and some retail chains such as Kroger with rates below the cost of drugs.
“Although a ‘new’ solicitation for the TRICARE pharmacy network was recently sent out, our members report that the contracts are virtually identical in terms of reimbursements to the ones sent out this summer,” the letter added.
Express Scripts responded to Fierce Healthcare that more than 2,000 independent pharmacies did accept the terms and will rejoin the network, with others having several days to respond. It added there are more than 40,000 pharmacies currently in the network.
The pharmacy groups also slammed Cigna’s decision to leave only one specialty pharmacy in-network: Express Scripts' sister company Accredo.
“The relationships between pharmacists and patients are built on trust, and for many patients is not something easily transferrable,” according to the letter, which included the National Association of Specialty Pharmacy and American Pharmacists Association among its signers. “Keeping patients’ trusted pharmacies in-network is critical to the patients’ care.”
Members of the groups have also complained that patients have reported missing doses and denials of sterile supplies needed to administer certain IV medications by Accredo.
Express Scripts defended the move to Accredo, noting in a statement to Fierce Healthcare that it was a "best-in-class specialty pharmacy that supports patients living with complex health conditions."
The PBM added that less than 1% of TRICARE members need a specialty pharmacy and that most are already on Accredo.
"We appreciate the continued feedback from industry organizations," the PBM said. "We take any concerns related to disruptions of care seriously, and if an issue does arise, we work swiftly with the patient and their doctor to address it.”
Lawmakers have criticized the decision by Cigna and Express Scripts to shrink their networks. Sen. Jon Tester, D-Montana, wrote a letter to the Department of Defense back in October outlining his concerns. Tester is chairman of the Senate Appropriations Committee’s defense subcommittee.
Reps. Buddy Carter, R-Georgia, and Mike Rogers, R-Alabama, were also concerned about the impact of the specialty pharmacy changes on patient access.
The letter is the latest in a long-running battle between PBMs and independent pharmacies and pharmacy groups. The pharmacies charge that PBMs and their insurer counterparts try to steer covered patients toward their own facilities.
“This is a perfect example of the anti-competitive nature of the industry we have been trying to shed light on for years,” said Hauser. “There is a large amount of steering going on here … to mail order or retail pharmacy.”