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.”
Express Scripts to add Humira biosimilars to formulary as preferred products 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.
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