The Defense Health Agency’s (DHA’s) federal contract with Express Scripts may be harming TRICARE beneficiaries, independent pharmacies, and American taxpayers, according to a bipartisan, bicameral contingent co-led by U.S. Rep. Buddy Carter (R-GA).
Cigna Healthcare owns Express Scripts, the second-largest pharmacy benefit manager (PBM) in the country, as well as mail-order specialty pharmacy, Accredo.
This vertically integrated structure allows Express Scripts to leverage its contract with DHA to keep much of its business in-house, steering TRICARE members to Accredo and putting competitors at a disadvantage, including rural, independent pharmacies that largely serve U.S. service members and their families, according to a June 26 letter that Rep. Carter and 23 of his colleagues sent to Assistant Secretary of Defense for Health Affairs Dr. Lester Martinez-Lopez and DHA Director Lt. Gen. Telita Crosland.
“Since the DHA granted Express Scripts its exclusive TRICARE contract in 2009,” wrote the lawmakers, “the company has consistently leveraged its market power to squeeze independent pharmacies and steer TRICARE beneficiaries to their own mail-order pharmacy and used other tactics to increase costs for service members and taxpayers.”
For example, Express Scripts appears to routinely under-reimburse pharmacies at cancer clinics for expensive cancer drugs, they wrote, and when pharmacies reject Express Scripts’ “predatory terms,” patients are forced to use Accredo’s mail-order pharmacy, which they noted is prone to delays and safety issues, but drives more profits to parent company Cigna.
Among the lawmakers who joined Rep. Carter in signing the letter were U.S. Sens. Mike Rounds (R-SD) and Elizabeth Warren (D-MA), and U.S. Reps. Stephanie Bice (R-OK) and Adrian Smith (R-NE).
To better understand DHA’s oversight of Express Scripts, Rep. Carter and his colleagues requested answers to several questions, including whether TRICARE has conducted any pricing reviews to determine if Express Scripts is charging more for drugs through Accredo than it charges for these drugs at independent pharmacies, and, if so, what the reviews determined.
“We are concerned that Express Scripts may be employing… [anticompetitive] tactics to overcharge TRICARE – a taxpayer-funded program – for drugs dispensed at Accredo, leveraging its TRICARE contract to underpay competitors and overpay its related companies,” wrote the lawmakers.