Today, Representatives Frank Lucas (OK-03), Tom Cole (OK-04), Markwayne Mullin (OK-02), Kevin Hern (OK-01), and Stephanie Bice (OK-05) announced that Express Scripts (ESI), the pharmacy benefits manager for the U.S. Department of Defense (DoD), will extend an additional opportunity for independent and community pharmacies to join the TRICARE Pharmacy 5th Generation (TPharm5) network. On December 1st, the TRICARE pharmacy contract will be shared with pharmacies and Pharmacy Services Administrative Organizations (PSAO) who will have until December 16th to rejoin the network. The action is welcomed news for Oklahoma’s veterans, service members, and their families who rely on rural and community, independent pharmacies for their prescription access.
“Over the past few months, it came to our attention that many of Oklahoma’s veterans and their preferred family-owned pharmacies would be losing prescription access and access to the TRICARE network. After multiple calls demanding accountability for their actions, the Defense Health Agency and Express Scripts has announced a change to ensure that these benefits aren’t lost. Oklahoma is home to more than 290,000 veterans and thousands of active-duty military members and their families who depend on TRICARE. We believe every military service-member, veteran, and TRICARE beneficiary deserves to have easy and convenient access to the military health care and benefits they dutifully earned, which is why we value the Department of Defense’s and Express Scripts’ decision to extend additional time for independent pharmacies to join the new TRICARE network,” said the Members. “Family-owned, independent and community pharmacies are important in ensuring Oklahoma’s rural communities and our cities’ suburbs have accessible health care options. We are privileged and honored to serve Oklahoma’s veterans, service members, and their families and the family-owned businesses that help provide them the care they deserve.”
As recently as 2021, over 56,000 pharmacy retailers were recognized within the TRICARE network. TRICARE beneficiaries include active-duty service members, veterans, and their families. However, as a result of ESI’s newly negotiated contract on behalf of the Defense Health Agency (DHA), nearly 15,000 pharmacy retailers are no longer part of the TRICARE network, as of October 24th. The exodus of pharmacy retailers leaving the network leaves roughly 400,000 beneficiaries living in suburban, rural, and underserved communities with limited access to care- including thousands across Oklahoma.
On November 14th, ESI announced it would reopen the contracting process to allow for more independent and community pharmacies to join the TRICARE retail network next year. Independent pharmacies – including those affiliated with a Pharmacy Services Administrative Organization (PSAO) – will receive a notice from Express Scripts regarding the update and next steps. On December 1st, the TRICARE pharmacy contract terms and conditions will be shared with pharmacies and PSAOs, who must respond by December 16th to rejoin the network, effective January 15, 2023.
Pharmacies that have questions related to the update may reach out to FederalRecontracting@express-scripts.com.