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After three years, Walmart leaves the Tricare pharmacy network – a departure which, according to the manager of pharmacy benefits, Express Scripts, is the result of the retail giant’s reluctance to offer “more competitive discounts” to beneficiaries military health.
At the same time, CVS Pharmacy will return to the Tricare network after a five-year hiatus, Express Scripts spokesperson Jennifer Luddy said on Wednesday would expand the choice within the network.
As of December 15, 2021, Walmart and Sam’s Club will no longer be part of the Tricare pharmacy network and CVS will be included in the list of retail pharmacies in the network where Tricare users can fill their prescriptions.
“This change offers more competitive rates for Tricare pharmacy benefits and expands the choices of quality and convenient pharmacies nationwide,†Luddy said in a statement to Military.com.
Walmart and Sam’s Club have more than 5,300 locations nationwide, according to the Walmart website.
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Walmart joined the Express Scripts network in 2018, signing a three-year contract to provide prescription services to clients of the pharmacy benefits management company, including Tricare and the Defense Health Agency.
The contract expires in December and Walmart and Sam’s Club will be taken off the network, Luddy said. Walmart did not return a request for comment by post.
Meanwhile, CVS, a company that left the Tricare network in 2016, also after negotiations failed, will return to the network, giving beneficiaries access to its nearly 10,000 pharmacies, including inside. many Target stores.
Under the agreement, effective December 15, all prescriptions filled at a Walmart will be considered off-grid. Beneficiaries will need to pay the full cost of their medications up front and file a claim with Tricare for partial reimbursement.
Access to Walmart pharmacies has been particularly convenient for military families who live in rural or remote areas who may not have a chain drugstore. But Luddy said Walmart “turned down several opportunities to offer more competitive discounts to continue serving Tricare recipients.”
As the manager of pharmacy benefits, Express Scripts acts as a sort of go-between, overseeing the Defense Health Agency’s pharmacy program, determining reimbursement rates for retail pharmacies that fill patients’ prescriptions, and billing the government in turn. .
It is also responsible for transactions involving the government purchase of drugs for military installations and provides the Tricare mail order pharmacy program.
Over the past decade, the Defense Health Agency has increasingly encouraged – and in some cases, required – recipients to fill their prescriptions free of charge at military pharmacies or to use the mail order system to fill prescriptions to long term at lower cost.
Pharmacy quotas have increased dramatically over the past 10 years, largely due to cost, but also as demanded by Congress as part of a cost-cutting measure to the defense medical budget.
In 2011, 30-day prescriptions for generic and brand-name drugs could be purchased at a network pharmacy for $ 3 and $ 9, respectively, while drugs not on Tricare’s formulary cost $ 22.
The mail order system offered free generic and brand name drugs for a co-payment of $ 9 for 90-day prescriptions.
This year, Tricare beneficiaries are paying $ 11 for a 30-day supply for a generic drug and $ 33 for a brand-name drug at retail pharmacies. Drugs not listed on the formulary that are not on Tricare’s list of covered drugs cost $ 60.
Co-payments for the mail-order pharmacy are $ 10 for a generic prescription and $ 29 for a brand name drug for a 90-day script. And rates are expected to rise next year.
Luddy said that Express Scripts will contact patients who are taking specialty medications to help them transfer their prescriptions without interrupting coverage.
According to Express Scripts, the Tricare pharmacy network covers 56,000 stores, including chains such as Walgreens and Rite Aid and supermarkets like Kroger and Publix.
Tricare covers 9.6 million beneficiaries worldwide.
–Patricia Kime can be contacted at Patricia.Kime@Military.com. Follow her on Twitter @patriciakime.
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