Members of Congress are asking the Defense Health Agency whether the Tricare pharmacy benefit manager, Express Scripts, a Cigna company, is using its market leverage to raise drug prices and limit competition. (Pixabay)
Members of Congress are asking the Defense Health Agency whether the Tricare pharmacy benefit manager, Express Scripts, a Cigna company, is using its market leverage to raise drug prices and limit competition.
In a June 26 letter to DHA director Lt. Gen. Telita Crosland and Dr. Lester Martinez-Lopez, assistant secretary of defense for health affairs, 24 senators and representatives expressed concern that Express Scripts may be limiting access to medications for Tricare beneficiaries, thereby driving up costs while overcharging independent pharmacies and taxpayers.
“Since the DHA granted Express Scripts its exclusive Tricare contract in 2009 the company has consistently leveraged its market power to squeeze independent pharmacies and steer Tricare beneficiaries to their own mail-order pharmacy, and used other tactics to increase costs for service members and taxpayers,” the letter states.
Cigna in 2018 purchased Express Scripts for $67 billion, combining it with its own mail-order pharmacy, Accredo. Express Scripts, an online pharmacy, as the Tricare pharmacy benefit manager provides prescription medication for 9.6 million service members, retirees and their families.
“However, because Cigna also owns Accredo, it can effectively keep much of its business in-house, using its [pharmacy benefit manager] to steer patients to its own pharmacy while disadvantaging competitors,” the letter states.
Express Scripts imposes “predatory terms” on other pharmacies willing to work with Tricare, the congressional members alleged. When pharmacies reject those terms, more Tricare patients turn to Accredo, a specialty pharmacy, “which is prone to delays and safety issues, but drives more profits to parent company Cigna,” the letter states.
Express Scripts did not reply to an email inquiry Monday from Stars and Stripes seeking comment.
However, Express Script, in a statement to Military Times published Saturday, said Tricare beneficiaries aren’t required to fill specialty prescriptions through Accredo, “though many choose to because of the highly personalized support they receive from their pharmacists, nurses, clinicians, dietitians and social workers.”
The members’ letter asked DHA to explain by Tuesday how it tracks Express Scripts’ denial of coverage for expensive specialty drugs, and whether Tricare has determined if Express Scripts is charging more for drugs through Accredo than it charges at independent pharmacies.
DHA had not yet responded to the letter, agency spokesman Peter Graves told Stars and Stripes via email Monday.
This is not the first inquiry from members of Congress on prescription drug costs.
In November, U.S. Sens. Elizabeth Warren, D-Mass., who signed the June 26 letter, and Mike Braum, R-Ind., wrote Christi Grimm, inspector general of the U.S. Department of Health and Human Services, airing concerns about vertical integration in the health care industry raising already high prescription drug costs.
“In particular, we are concerned by a recent report suggesting that large insurance companies – including Cigna, CVS Aetna, and UnitedHealth – are hiking drug prices at their vertically integrated specialty pharmacies to evade the Medical Loss Ratio, a statutory requirement for health insurers to spend at least 80 or 85 percent of health care premium dollars on medical claims,” the 2023 letter stated.
