Arkansas veterans, lawmakers say PBMs slowing access to pharmacies, adding extra steps to get prescriptions

LITTLE ROCK, Ark. – Pharmacies and veterans are expressing frustration over what they call an uphill battle with filling prescriptions, with both pointing to the insurance company used by many veterans as the one needing to fix the problems.

Many veterans continue to experience problems with getting necessary prescriptions are local pharmacies. Some of them point to pharmacy benefit managers (PBMs), a kind of insurance sub-contractor administering prescription for health insurance companies, as the main reason they have to jump through so many hoops to get their medications.

State Rep. Brandon Achor (R-Maumelle), who also owns Achor Family Pharmacy, said he believes the problem is the use of a PBM by TriCare, one of the leading veterans insurance providers.

The lawmaker said the levels of administration and rules is keeping veterans from being able to get their prescriptions filled at locations nearby to them, leaving many veterans with TriCare coverage to get prescriptions filled by mail order through Xpress scripts.

“It’s extremely frustrating,” Achor said. “I tell people all the time… illness is a scary thing. People don’t want to be scared with their mailbox. They want to be scared with their local pharmacist.”

Attorney General Tim Griffin, who is himself a veteran, said this challenge has impacted him personally.

“I was looking around with my family and there just weren’t many options,” Griffin said. “I even had one pharmacist say, ‘Look, we really don’t take it, but we hate to have service members left without an option near where they live, so we’ll do it and try to make it work even if there’s a loss on some stuff.’”

PBMs were created to negotiate terms for prescription drug costs for millions of Americans, setting prices with drug companies, paying pharmacies, determining the drugs accessible to patients and helping set drug costs.

These PBMs are under fire by federal officials, though, with a recent report from the Federal Trade Commission finding that the companies may be “may be profiting by inflating drug costs” while also “squeezing Main Street pharmacies.”

“PBMs can squeeze independent pharmacies that many Americans — especially those in rural communities — depend on for essential care,” FTC chair Lina Khan recently said.

When contacted about these claims, a spokesperson for Express Scripts provided a statement saying in part that it worked to make sure customers on TriCare plans had access to multiple near by pharmacy options, claiming that 95% of its Arkansas beneficiaries are within 15 minutes of an in-network option.

“We ensure that TRICARE beneficiaries have affordable access medicines through a broad network of chain, independent, military, specialty and home delivery pharmacies, and more than 95% of Arkansas beneficiaries has an in-network pharmacy within 15 minutes of their home. We are always dedicated to providing more choice to beneficiaries and we are working to welcome more independent pharmacies to our network. We are committed to supporting the important role that independent pharmacies play in their communities, which is why we launched our IndependentRx initiative to deepen our partnership with these pharmacies and increase their reimbursements for additional services like vaccinations and screenings.

“We know that any change to health care services can be challenging, which is why we proactively update beneficiaries who may be impacted well ahead of any change to our pharmacy network, and have a team working to support them. We encourage any beneficiary with questions to contact us at DoD.Customer.Relations@express-scripts.com or 1-877-363-1303.”

A spokesperson for TriCare’s said the company has a program geared towards partnering more with independent pharmacies like Achor Family Pharmacy.

Achor countered that this is a game of waiting and seeing, adding that something he won’t be waiting on is taking action if veterans don’t see changes soon.

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