PBM’s can legally do anti-competitive behavior with impunity ?

Tricare Pharmacy Network Adds Walgreens, Removes CVS


Isn’t this interesting… the PBM Express Scripts is one of the LARGEST PBM in the country as is CVS’ Health.. Caremark (PBM) division. So Express Scripts cancelled its contract with CVS to fill the prescriptions for TriCare –  which encompasses active/retired military…   So out of the some 68,000 community pharmacies in our country.. only the 9,600 CVS pharmacies – competitor of Express Scripts… gets pushed out of the network..  Since Express Scripts is legally an insurance company which makes them exempt from Sherman Antitrust Act by the McCarren Ferguson Act  1945 https://en.wikipedia.org/wiki/McCarran%E2%80%93Ferguson_Act 

which basically exempt insurance companies from the Sherman Antitrust Act… like anti-competitive practices and other things that are ILLEGAL for “normal businesses”.

When McCarren Ferguson was passed.. most all insurance companies were mutual companies … not for profit and “owned” by their policy holders… during the 90’s many/most of these mutual insurance companies “de-mutalized” and became publicly traded – FOR PROFIT companies.  AND where was Congress to allow these  FOR-PROFIT companies to continue to be allowed to violate the Sherman Antitrust Act with impunity ?  Maybe the collective “lobbying money” flowing to member of Congress was enough to convince them to ignore this little over sight.  Another good example of once a law is passed… it is never repealed… regardless of how inappropriate it may have become and/or how it gives certain competitors advantages over their competitors ?

This is the same set of laws that allows these same group of PBM’s to all – about the same time – exclude the same medications or class of medications from their formularies… without being accused of acting in collusion.

Walgreens will soon rejoin Tricare’s pharmacy network for users nationwide, officials announced Friday, while CVS pharmacies will leave.

That means Tricare users will now be able to fill their prescriptions off-base at Walgreens pharmacies without paying out-of-network rates, and CVS users will need to find a new pharmacy or pay unsubsidized rates for their medications.

The change takes effect Dec. 1, officials said. It will impact all beneficiaries, including Tricare for Life users and military retirees. The network will add about the 8,000 Walgreens stores and lose more than 9,600 CVS pharmacies.

“Starting Dec. 1, 2016, Walgreens pharmacies will join the Express Scripts, Inc. network serving Tricare beneficiaries across the United States,” Tricare officials said in a news release. “Additionally on Dec. 1, CVS pharmacies, including those in Target stores, will leave the network.”

Poll: How will the Tricare pharmacy change impact you?

More than 59,000 pharmacies are in the Tricare network, Express Scripts officials said. As of Dec. 1, that number will drop to 58,000, they said. Tricare currently serves about 9.4 million beneficiaries.

Despite the switch and drop of about 1,000 Tricare network pharmacies nationwide, about 98 percent of users will continue to have access to at least one in-network pharmacy within a one to five mile radius of their home, officials said.

The change came after a series of recent contract negotiations with retail pharmacies, officials said.

“As part of our contract with Tricare, Express Scripts helps the Department of Defense maintain an affordable pharmacy benefit by continuing to secure competitive rates with retail pharmacies,” Jennifer Luddy, an Express Scripts spokesperson said in a statement. “This change is intended to provide better value to Tricare and maintain convenient access for beneficiaries.”

The switch will also impact users who rely on Coram for speciality medications provided by mail-order since that service is a part of CVS.

“When CVS leaves the network, beneficiaries currently using Coram/CVS to fill their prescription will need to switch their prescription to another speciality network pharmacy,” Tricare officials told Military.com. Officials said Kroger, which is a current retail pharmacy provider, as well as Walgreens will both become speciality network pharmacies starting Dec. 1, and may carry the medications previously supplied by Coram.

“Beneficiaries filling specialty drugs will receive additional outreach to ensure they are able to move their prescription to a new network pharmacy with no disruption in their prescription therapy,” Tricare officials said.

Walgreens had previously been a Tricare in-network pharmacy. But a 2011 contract dispute over reimbursement rates from Tricare’s drug contractor Express Scripts resulted in the store leaving the network. At the time, Walgreens brought in an estimated $5.3 billion in annual revenue from the system. And although they later resolved the overall dispute with Express Scripts, the decision to exclude Tricare’s business from the retailer did not change.

“Walgreens is very proud to partner with Express Scripts to serve the Department of Defense and Tricare beneficiaries,” company officials said in a statement Friday. “We will work closely with Express Scripts in the next two months to ensure a smooth transition to Walgreens.”

Officials with CVS did not respond immediately to requests for comment.

— Editor’s note: This story was updated to include additional information on CVS-based services and statements Express Scripts and Walgreens.


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