Active and retired Montana military members could face hours of windshield time to secure life-saving medications because of a reduction of local pharmacies covered by their health insurance, state and federal officials have warned.
Beginning Monday, nearly 15,000 independent pharmacies across the country will no longer be in-network with Tricare, the U.S. military’s health care program and government-managed health insurance. That pharmacy network is managed by Express Scripts, a contractor with Tricare.
While it’s unclear how many pharmacies in Montana may be affected, or where those pharmacies are located, the reduction is expected to hit roughly 400,000 Tricare recipients nationwide, according to federal officials’ estimates.
Montana had 37,683 Tricare beneficiaries in fiscal year 2020, the more recent year with available data, according Master Sgt. Michael Touchette with the Montana National Guard Public Affairs Office.
“According to Express Scripts service center, those Tricare recipients who are affected by this change will be notified by mail that their pharmacy is no longer in network and will have the option to switch to another in-network pharmacy in their community or have eligible medications switched to home delivery,” Touchette said in an email to the Montana State News Bureau this week.
The Montana National Guard has not received any requests for help nor any complaints about the Tricare reduction, Maj. Ryan Finnegan, also with the Montana National Guard, said.
Still, Montana State Auditor and Commissioner of Insurance and Securities Troy Downing last week called on the Biden administration to intercede in Express Scripts’ decision to reduce the number of in-network Montana pharmacies, saying the change puts Montana veterans and their families at risk.
“Montana veterans, who served with honor and distinction, deserve greater and more convenient access to their prescriptions — not less. Allowing this plan to move forward threatens our veterans by removing critical access to prescription drugs,” Downing said in an Oct. 12 press release. “This is a D.C. decision that fails to consider the needs of rural states. This policy will harm Montana service members, retirees and their families.”
In its own press release last week, Defense Health Agency’s pharmacy operations division chief Edward Norton Jr. said the network will still include 40,000 pharmacies.
“The Defense Health Agency is confident that the new pharmacy contract maintains the quality of the Tricare retail pharmacy network,” Norton Jr. said. “Some independent pharmacies are leaving, but Tricare families will continue to have access to an excellent network of pharmacies.”
In Havre, Gary & Leo’s pharmacy co-owner Eric Ward estimated he had over 100 Tricare recipients before his pharmacy was cut from the Tricare network earlier this year.
“More of them were retired,” Ward said. “We tended to see them more than anyone.”
The Havre Walmart has already been removed from the Tricare network, Ward said, and another pharmacy Ward’s company just purchased was set to lose their contract with Tricare on Jan. 1, 2023.
Ward also chairs the Montana Pharmacy Association, which voiced its concerns this week about the reduction, pointing to the Department of Defense awarding its entire network management contract to Express Scripts, a pharmacy benefit manager, which is often referred to as PBM. Managing the entire pharmacy network in a single contract allows PBMs in the middle-man role like Express Scripts to take a greater share of the claim recipients make to the insurance agency. The result is a smaller reimbursement rate for pharmacies, like Ward’s.
“It was costing me money every time a patient with Tricare came in,” he said.
And it’s not just the arrangement between Express Scripts and Tricare, Ward added. PBMs have had a serious impact on pharmacies around the state. In Great Falls, three of the four independent pharmacies have shut their doors in recent years due to the dwindling reimbursement rates set up by PBMs, Ward said.
One pharmacy clinic in Havre, which did not return a call seeking comment for this story, is still in network for Tricare recipients, Ward said, but he’s not sure how long that may last. Last year Tricare announced Walmart was leaving its network, and CVS would take its place. Havre has a Walmart, but not a CVS.
Tricare recipients can still have medications delivered to them through Express Scripts’ program, but, as federal officials have pointed out, mail service can be inconsistent, especially in rural places and particularly in the winter.
“Trying to force (Havre recipients) into the CVS network, that’s 120 miles from here,” Ward said, pointing down the road to Great Falls. “When you need an antibiotic, you can’t drive 120 miles when you’re sick. You can’t really plan on when you’re sick and order two weeks ahead of time for it to show up in the mail.”
Emails seeking comment from Tricare and Express Scripts were not returned Wednesday.
Downing’s call on the federal administration joined a chorus of federal officials, including the entirety of Montana’s bipartisan congressional delegation, in denouncing the reduction.
U.S. Sen. Jon Tester, a Democrat who chairs the Senate appropriations subcommittee on defense, sent a letter in late September to Under Secretary of Defense and Personnel Readiness Gilbert Cisneros to take action.
“No longer able to rely upon their local pharmacy to access needed medication and in-person pharmacist counseling, (beneficiaries) would be forced to drive long distances to find corporate in-network pharmacies or be funneled into Express Scripts’ mail delivery program,” Tester wrote. “That is unacceptable.”
U.S. Sen. Steve Daines, a Republican, was one of 100 U.S. senators and representatives who issued a letter to Acting Assistant Secretary of Defense for Health Affairs Seileen Mullen seeking more information on the reduction in pharmacies as well as reimbursement rates that could affect continuing pharmacies’ ability to operate. The reduction in pharmacies, the letter notes, is taking place two months earlier than planned.
In an emailed statement this week, U.S. Rep. Matt Rosendale, a Republican, noted an approved pharmacy under the new structure could be 30 miles or more away and mail service can be inconsistent.
“The Defense Health Agency must reconsider this change that will very likely risk the health of Montana service members and veterans,” Rosendale said.
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