From Military.com:
“Walmart Out, CVS In: Changes
Coming to Tricare's Pharmacy Network”
After three years, Walmart is
leaving Tricare's pharmacy network -- a departure that pharmacy benefit manager
Express Scripts says is a result of the retail giant's reluctance to offer
"more highly competitive discounts" to military health beneficiaries.
At the same time CVS Pharmacy will return to the Tricare network after a
five-year hiatus, a change Express Scripts spokeswoman Jennifer Luddy said
Wednesday would expand choice within the network.
Effective Dec. 15, 2021, Walmart
and Sam's Club will no longer be a part of the Tricare pharmacy network, and
CVS will be included among the list of network retail pharmacies where Tricare
users can fill their prescriptions. "This change provides more competitive
rates for the Tricare pharmacy benefit and expands quality, convenient pharmacy
choices nationwide," Luddy said in a statement to Military.com. Walmart
and Sam's Club have more than 5,300 locations nationwide, according to
Walmart's website. Walmart joined the Express Scripts network in 2018, signing
a three-year contract to provide prescription services to the pharmacy benefit
management company's clients, including Tricare and the Defense Health Agency. The
contract expires in December and Walmart and Sam’s Club will be removed from
the network, Luddy said. Walmart did not return a request for comment by
publication.
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 pharmacy
locations, including inside many Target stores. Under the agreement, as of Dec.
15, all prescriptions filled at a Walmart will be considered non-network.
Beneficiaries will have to pay the full cost of their medication up front and
file a claim with Tricare for partial reimbursement. Having access to Walmart
pharmacies has been especially convenient to military families who live in
rural or remote areas that may lack a chain pharmacy. But Luddy said Walmart
"declined several opportunities to offer more highly competitive discounts
to continue to serve Tricare beneficiaries."
As a pharmacy benefit manager,
Express Scripts serves as somewhat of a middleman, overseeing the Defense
Health Agency's pharmacy program, determining the reimbursement rates to retail
pharmacies that fill patient prescriptions, and billing the government in turn.
It also is responsible for transactions involving the government purchase of
medicines for military installations and provides the Tricare mail-order
pharmacy program. In the past decade, the Defense Health Agency has
increasingly encouraged -- and in some cases, required -- beneficiaries to fill
their prescriptions at no cost at military pharmacies or use the mail-order
system to fill long-term prescriptions at lower cost. Pharmacy copays have
risen substantially over the past 10 years, in large part due to cost but also
as required by Congress as part of a cost-cutting measure to the defense
medical budget. In 2011, 30-day prescriptions of generic medications and
brand-name drugs could be purchased at a network pharmacy for $3 and $9
copayments, respectively, while medications not in Tricare's formulary cost
$22. The mail-order system offered generic medications at no cost and
brand-name formulary drugs for a $9 copayment for 90-day prescriptions.
This year, Tricare beneficiaries
pay $11 for a 30-day supply for a generic drug and $33 for a brand-name
medication at retail pharmacies. Non-formulary drugs not listed in Tricare's
list of covered medications cost $60 Copayments for the mail-order pharmacy run
$10 for a generic prescription and $29 a brand-name drug for a 90-day script.
And the rates are expected to rise next year. Luddy said that Express Scripts
will be reaching out to patients who take specialty medications to help them
transfer their prescriptions without a gap in 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
provides coverage to 9.6 million beneficiaries worldwide.
^ Tricare is not the best health
care insurance as it is and when you have to use their mail-order prescription
service (which they force you to do) then it is more inconvenient. Taking
Wal-Mart off the approved list of pharmacies will make things even more
difficult for Military Families and Veterans. ^
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