A Senate Armed Services Subcommittee on Personnel hearing last week focused on the Pentagon’s contract with Cigna’s Express Scripts, the pharmacy benefit manager that administers the TRICARE pharmacy program. The company oversees prescription coverage for approximately 9.6 million active-duty personnel, retirees, and their families.
Sen. Elizabeth Warren, D-Massachusetts, questioned Express Scripts President Dr. Adam Kautzner regarding contract provisions that allow the company to retroactively adjust pharmacy reimbursements after a prescription is processed. Warren stated that the company takes billions of dollars from taxpayers while refusing to submit to audits.
"I’m pretty outraged that you drag in billions of dollars from taxpayers and that you won’t submit to an audit when it’s clear that you have the opportunity to bilk the federal government," Warren said.
The hearing also addressed the exclusion of independent pharmacies from the TRICARE network. Dr. Micah Lansford, a pharmacist and owner of Roden-Smith Pharmacy, testified that he was recently forced out of the program. When asked by Sen. Tommy Tuberville, R-Alabama, about the reason for the exclusion, Lansford cited unsustainable industry practices.
Lansford told the committee that pharmacy benefit managers and their parent insurance companies underpay local health care networks. He added that the current TRICARE contract would have been the worst agreement his pharmacy could have joined.
Greg Reybold, vice president of public policy at the American Pharmacy Cooperative Inc., described the retroactive reimbursement provision as a "smoking gun" in a complex financial arrangement. He characterized the practice as a shell game that allows the company to keep the difference between what it pays pharmacies and what it charges the government.
