Almost 15,000 pharmacies out of Tri-Care, pols want to know why

| October 4, 2022

14,963 pharmacies have been confirmed as ceasing participation in TriCare.

The letter comes after the Defense Health Agency, or DHA, confirmed that 14,963 retail pharmacies will no longer participate in Tricare’s pharmacy network, which is administered by Express Scripts, starting Oct. 24.

Some independent pharmacies knew they would be dropped from Tricare next year because they wouldn’t accept the terms of Express Scripts’ contract, which included lowered reimbursement rates. But many have been blindsided by the Oct. 24 date, an advocacy group for independent pharmacies told Military.com last week.

A letter from over 100 lawmakers 18 Senate Republicans and 80 House members, mostly Republicans with a handful of Democrats) to Seileen Mullen, the acting assistant secretary of defense for health affairs, is asking why Tri-care is closing their contracts October 24 (instead of EOY) saying it will lead to:

“patient access and safety” issues resulting from the reductions. “This will only further reduce the pharmacy network for Tricare patients and their families, and may force beneficiaries to change pharmacies at a time when many receive annual vaccinations,” they wrote in the letter.

Military.com

Sounds like Express Scripts is working with the various pharmacies on the same basis as Medicare works with doctors: respondents to both complan of inadequate and slow repayment.  I suspect they would say they “pay exactly on time from when payment is approved” but dodge how long it takes to actually approve payments.

Category: "Your Tax Dollars At Work", Pentagon

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5JC

I’ll take “What happens when Tricare treats pharmacies like they are service members or dependets” for $1000.

Green Thumb

Everything I saw pointed to the fact that rural areas are going to get hardest.

SFAlphaGeek

Yeah, I got the letter yesterday telling me that our small-town pharmacy was no longer participating as of Oct 24th.

Grunt

I’m guessing the BigPharm lobby won out- where I’m at, all the mom-n-pop pharmacies are no longer in network but alas, CVS / Walgreens, with their shitty customer service, perpetual out-of-stock of common meds, and penchant for hiring TCNs as the pharmacy staff remain.

Anonymous

BOHICA!

Jay

Its all about the money. Why cater to a handful of military families when you can spend your time/efforts catering to the MILLIONS of people on Medicaid? Medicaid is state funded and has a more stable network and history of paying timely/promptly.

MI Ranger
  1. Admit nothing
  2. Deny Everything
  3. Make Counter-accusations

Try getting a non-standard medicine…nothing available!! My daughter needs a less than .1% Atropine eye drop, we had to go outside of Tri-Care because no-one could delute the formula!

AW1Ed

To serve you better!

Anonymous

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jeff LPH 3 63-66

Great Twighlight Zone episode. I really ate that one up watching it way back when.

SFC D

Must be run by AAFES.

Green Thumb

Heard about this a while back.

SKYJUMPER

When I was around 68 years old, I got a prescription from my doctor for Chandix, because I wanted to quit smoking.
Went to the local pharmacy to pick it up and they told me TriCare denied it, but never explained to the pharmacy why.

After a couple of hours and finally after talking to two people at Tricare (both said they didn’t know why I was denied, but offered no help to find out the explanation) I finally got someone who explained the reason why. It seems like I fell under “the rule of 65), which means that once a person turns 65 or older, TriCare will deny the prescription. Guess they don’t won’t anyone to be a financial burden on them.

FuzeVT

And if you keep smoking you’ll die faster. 3d chess. . .

Anonymous

It reduces their budget actually filling prescriptions for sick people, you know.

Last edited 1 month ago by Anonymous
SFC D

Chantix wasn’t covered for active duty in 2007. I had to pay for it 100%. Wasn’t cheap but it worked.

Last edited 1 month ago by SFC D
MustangCryppie

Anybody who wants to stop smoking, get the book “The Easy Way to Stop Smoking” byAllen Carr. Worked for me 24 years ago. Easy peasy.

Skivvy Stacker

Or, contract COPD and early on-set emphysema like I did. That’s a sure way to make you quit.

timactual

“Easy peasy.”

Nothing personal, but I just don’t believe there is an easy way to quit smoking. I quit ‘cold turkey’ (thanks to a medical thing and some prescription drugs) about 30 years ago. It took me a couple of years and I still miss it. I remember with fondness the smell of a freshly unwrapped pack of Camels (or any other brand in a pinch). I miss going through the check-out counter of a grocery store and getting a whiff of the cigarettes conveniently stacked nearby. I miss……
Aargghh!
(furiously chews fingernails)
I CAN HANDLE IT!

5JC

As a retireee when you turn 65 you must enroll in Medicare A&B and then Tricare for Life. It’s been that way for 2 decades.

FuzeVT

Every time I look at my “Explanation of benefits” I see either the pharmacy for doctor getting screwed. I wonder why any of them would take Tricare unless they considered it Pro Bono work.

Jay

Another reason I don’t go to the Doctor.

Jay

Another reason organized medicine is a crock: my daughter broke her hand over the spring. Today was her last visit to the orthopedist to make sure the bones healed right/she didn’t need OT. After factoring how much the referral to a specialist was, I had the PRIVILEGE of paying a 33.00 copay to have the guy come in for 2 minutes, “yep, she looks great!”

MustangCryppie

Hell, i got out of the hospital and was told i had to see my PCM. 5 minute visit. Over $1000 bill. I paid only a fraction of that, but still, WTF! Oh, i meant to say my former PCM. Fucker.

Last edited 1 month ago by MustangCryppie
Skivvy Stacker

Hell, I’d have done that for free, and you’d have gotten; “yep, she’s adorable”.

Docduracoat

Jay,
I am at a loss to explain what you are complaining about.
You could have someone who doesn’t know anything about orthopedic surgery exam in your child for $5.
And he could take an hour to perform a pretend exam.
And that would be a total waste of an hour of your time and five dollars of your money
You had someone who is expert in orthopedic surgery, with 10 or more years experience, examine the hand and determine in five minutes that it is healed perfectly.
And it cost you $33 and a few minutes of time.
And you got an expert opinion.

And I’m going to presume that if there were a complication, he would have the expertise to diagnose it, order tests and deal with it.
So is your complaint that an expert doctor initially made a diagnosis in a few minutes?