Tricare is health insurance for  active/retired members of our armed services and many US government employees.  Tricare changed their PBM’s to Express Scripts and they sent out contracts that provided reimbursements to – at least – independent pharmacies that was BELOW THE COST OF WHAT PHARMACIES HAD TO PAY TO PURCHASE THE MEDICATION FROM THEIR DRUG WHOLESALER.   It is generally consider a necessary business fact that any business that sells a product or service for LESS THAN what the product or service costs them to provide – will most likely not survive very long as a functioning business.  The non-negotiable contract that is being offered, will mean that abt 15,000 of independent pharmacies will have little choice but to decline to accept this contract. That is about 25%  of all community pharmacies are independent pharmacies and > 50% of independent pharmacies are located in cities/towns of < 20,000 population, areas that will not financially support the typical 15,000-18,000 sq ft chain pharmacies.  It is claimed that some per-cent of Tricare folks will have to drive 30 minutes in each direction to find the closest Express Scripts in network pharmacy.  I have read that any pt with Tricare coverage will be mandated – after the original Rx fill and 2 refills – will be mandated to use Express Scripts mail order pharmacy services – or pay full price at the local pharmacy independent or chain.

FDA has required temp storage for all Rx meds and even many OTC meds – The majority of medications are recommended to be stored at room temperature, between 59 to 77 degrees Fahrenheit.  Any medication that is exposed to 10F +/- of its required temp storage >24 hrs.   Its potency may be compromised, but the FDA doesn’t bother to monitor or enforce this temp storage requirement.  How many has seen a Fed-X, USP, USPS delivery vehicle that is “temp controlled”.  How many have seen their Rxs meds sent from a mail order pharmacy was <24hr in the delivery system from the mail order pharmacy to a pt’s mailbox ? The standard “bubble mail envelope” or cardboard box provide little/no insulation from the ambient temp the Rx meds  is exposed to. Currently CVS is in a 3 yr time frame to close 900 pharmacies – abt 10% of their total store count.  One particular CVS store closure was on the news this week … that could create a pharmacy desert in a geographic area that had a high percent of the population being old/poor.  Not every newly created “pharmacy desert” is going to make the news.   Walgreen has closed nearly 24 pharmacies in the San Francisco area and this week Walgreens announced closing 4 stores – out of a total of 39 – in the Louisville, KY market.  This new Tricare pharmacy contract is going to create a lot of pharmacy deserts – especially in rural areas.

Probably those who are young/healthy/take few Rxs and/or live in large cities  will have little problems or inconvenienced by all of these changes in the Rx distribution system. But those who live in rural areas, areas without some sort of public transportation, poor/high acuity pts who needs a “boat load” of medications and wake up one morning in a pharmacy desert and mandating getting their Rxs from a mail order pharmacy.  Many who will end up being “collateral damage” and their health/QOL being compromises, because some of the Federal bureaucracies and for profit corporations place a “low priority” on the subset of our population.

Rep Buddy Cater, from Pooler, Georgia has been in the House since Jan 2015 and owns three independent pharmacies and has been the only pharmacist in Congress until a second pharmacist was elected from TN – Diana Harshbarger – who came to the House in 2021 and she and her husband own/run a independent pharmacy, Premier Pharmacy in Kingsport, TN.

There is a form on this hyperlink – https://buddycarter.house.gov/forms/form/?ID=133 – to share your comments and opinions in regards to the action of Dept of Defense moving all Tricare pharmacy business to Express Scripts.

Protecting Pharmacy Access for TRICARE Beneficiaries

https://buddycarter.house.gov/forms/form/?ID=133

Filed under: General Problems