Express Scripts feeling Growing Pains

On 11/04/09 TriCare, the health insurance plan for the US Military and its families are being moved to a new pharmacy benefit administered by Express Scripts. Despite assurances of transparency and no change in pharmacies, thousands of beneficiaries are being directed by Express Scripts to a single option for the most expensive drugs or specialty pharmacy products. This distributor is Curascript, wholly owned by Express Scripts.

 

Funneling a network of pharmacies into a single specialty pharmacy means that Express Scripts avoids sharing margin. While this is a potential boon to Express Scripts, it comes with a very serious concern on a contract that has not closed. This contract includes performance measures with penalties and possible action by the Department of Defense, its largest customer.

 

TriCare beneficiaries are already being told by Express Scripts that Curascript can not handle the volume of these new specialty pharmacy patients and that drug refills will take 2-4 weeks. If true that could invoke severe penalties from TriCare's new contract with Express Scripts not to mention the unnecessary risk and hospitalizations of these fragile patients which include children with hemophilia, adults with Hepatitis and Multiple Sclerosis.

Additionally, TriCare outlined before Congress in June its reform effort underscoring a policy of transparency. TriCare documents to beneficiaries assured them that the move to the ExpressNet 50 Network would not disrupt services or require a change in pharmacies. 

 

TriCare Management Activity (TMA) is the liaison with Express Scripts and DoD. Our firm is working with TMA in its investigation of these issues.

 

This author consults with leading institutions through GLG