Sunday 13 November 2022

WILCOX And COOK: The New Congress Can Score A Major Bipartisan Win By Restoring Veterans’ Pharmacy Access

 Veterans Day is an opportunity not only to honor those who have served our country in uniform. We must also help these heroes overcome some of the pressing challenges they face every day. At the top of this list of hurdles is navigating the friendly fire of the overcomplicated healthcare system.

The latest veteran healthcare threat is the recent move by Tricare, which provides health coverage for 10 million veterans and their families, to cut 15,000 independent pharmacies from its drugstore network.

This drastic pharmacy curtailment reduces the number of in-network drugstores by nearly 30%, threatening veterans’ access to prescription drugs, especially in rural and underserved areas. The incoming Congress elected on Tuesday can score an early bipartisan victory by restoring veterans’ access to community pharmacies.

What’s behind this dramatic and dangerous reduction of independent drug stores from the Tricare pharmacy network? It’s the same old story of health industry profiteering. 

Express Scripts, the pharmacy benefit manager that holds the $4.3 billion Defense Department contract to manage the Tricare pharmacy program, recently cut reimbursements to independent pharmacies to below medications’ costs. As a result, these pharmacies would lose money on every prescription they fill.

“It was a take-it-or-leave-it contract,” said Erich Cushey, a community pharmacist in Western Pennsylvania. “We can’t afford to sign that contract. We should be helping veterans wherever they choose to get prescriptions.”

Chris Antypas, another local pharmacist, said he’d lose between $10 and $100 depending on the prescription. “These are people we’ve taken care of forever. It’s hard to walk away from that. It’s an absolute disaster.”

By offering below-cost reimbursements, Express Scripts is driving independent pharmacies out of its network in order to redirect the prescription business to its affiliated pharmacies, including its online mail-order option and Walgreens.

Given that more than 90% of Americans live within five miles of a community pharmacy, and more than three-quarters of pharmacies in rural areas are independent, many veterans will experience reduced access to medications.

Their alternatives are often inadequate. Mail-order medications can’t be acquired quickly. These changes disproportionately affect rural veterans, many of whom do not have the time, money, or capacity to drive long distances to get their meds from an in-network brick-and-mortar location.

“I live in a rural area, and Express Scripts is canceling the in-network status [of] local pharmacies, which in some cases means a patient would have to drive up to 50+ miles to access an in-network pharmacy,” explains a community pharmacist in North Dakota.

Veterans in long-term care homes who enjoyed personalized service from their independent pharmacies may have the most to lose as they try to navigate this medication disruption. Even veterans who can seamlessly shift to purchasing online will still lose the counseling and peace of mind received from their trusted pharmacists.

The vertical integration of the healthcare industry among health insurers, PBMs, and pharmacies has thwarted competition, increasing costs and reducing access. As former pharmacist Rep. Buddy Carter explained in a recent episode of the Patients Rising Podcast, vertical integration is contributing to 4% of the nation’s independent pharmacies going out of business every year, generating “pharmaceutical deserts.” Meanwhile, these integrated healthcare behemoths are making out with record profits.

Congress has already shown interest in rectifying the Tricare problem. One hundred members of the House and Senate, representing both major parties, recently sent a letter to the Defense Department demanding answers. Sen. Jon Tester, chairman of the Senate Committee on Veterans’ Affairs, said the changes are “unacceptable” and asked the Defense Department to act.

The new Congress can pass a bipartisan legislative fix to prevent PBMs from lowballing independent pharmacies to consolidate business at their affiliated pharmacies. This proposed solution can act as part of broader legislation that addresses other veteran healthcare needs, such as faster access to mental health specialists and more help for those who developed cancers from exposure to toxic burn pits or other hazardous materials. Such action as a first foray for the new Congress would be a display of good faith to our nations’ most revered institution.

The best way to honor veterans on Veterans Day is by taking such specific actions to help them overcome their challenges. Veterans sacrificed for our country; now it is our turn to repay this service.

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