Express Scripts' partnership with Tricare is putting active duty military personnel and veterans at risk, the Community Oncology Alliance told the U.S. Department of Defense according to The Columbus Dispatch.
Express Scripts, the largest pharmacy benefit manager in the country, entered into an exclusive agreement with Tricare, the federal healthcare program for uniformed U.S. service members, retirees and their families, in 2009. Express Scripts handles all pharmacy reimbursements for Tricare.
Community oncology clinics have told the Defense Department that Express Scripts is forcing cancer patients to use its mail-order pharmacy, which can cause long delays in getting their lifesaving drugs, the Dispatch reported.
Express Scripts has also given preference to more expensive drugs, raising costs for patients. Mark Nelson, the CEO of Northwest Medical Specialties in Tacoma, Wash., told the Dispatch that he had a patient who was forced off the cheaper version of a cancer drug.
Ted Okon, executive director of the oncology alliance, told the Dispatch that Express Scripts is "lowballing reimbursement rates for oral cancer drugs to oncology providers" in both independent practices and hospital systems and making it impossible for providers to afford to give these drugs to their patients.
Using mail-order pharmacies can cause long delays in starting care, interruptions to ongoing care, and slowness to adapting to changes in care, the Dispatch reported.
Express Scripts told Becker's Hospital Review that it is providing customers with the most cost-effective options.
"One way we accomplish this is by having patients fill the medication at an in-network specialty pharmacy (not always exclusively an Express Scripts pharmacy or Accredo) rather than obtaining the medication from the physician’s office, where the medications are often marked up considerably. In this practice, the pharmacy provides the medication directly to the patient or the physician’s office or outpatient treatment center for administration," an Express Scripts spokesperson told Becker's.
A Tricare spokesperson told the Dispatch the agency hasn't had issues with mail-order pharmacies.
"We continuously monitor mail order pharmacy performance. There are no indications it is an inferior way for medications to be dispensed," the spokesperson said.
"Shipping via mail is a safe, convenient, and accepted method to ensure delivery of these medications and can help vulnerable beneficiaries, such as our oncology patients reduce unnecessary exposures to illness," a Tricare spokesperson told Becker's.
The oncology alliance has argued that Express Scripts forces customers to use Accredo, its mail-order pharmacy, to maximize its own profits.
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