Walgreens pharmacies no longer accepting TRICARE drug insurance [Ventura County Star, Calif.]

Jan. 09--Oxnard pharmacist Myhang Bach has been doing a lot of explaining along with filling prescriptions this week.

Bach is among the Walgreens pharmacists nationwide who must tell patients that the chain no longer accepts health insurance administered by pharmacy benefits manager Express Scripts.

Contract negotiations between Walgreen Co. and Express Scripts broke down in June. Walgreens then announced it would stop accepting insurance administered by Express Scripts beginning Jan. 1.

Among the prescription drug plans administered by Express Scripts is the TRICARE Pharmacy Program, which covers members of the military and their dependents.

"We have a lot of patients on Express Scripts, especially TRICARE," Bach said. "One is on active duty and gets transferred every few months. Now she can't go to the local Walgreens."

Walgreens has seven stores in Ventura County, including three in Oxnard. Bach said her Walgreens is closest to Naval Base Ventura County and that she has been dealing with surprised military personnel.

"One older lady whose husband retired from the military keeps calling me saying: 'What can I do? How can I stay?' " Bach said. "We have a lot of young mothers whose husbands are deployed. I just talked to a lady who was with us four or five years. Her father-in-law has Alzheimer's."

TRICARE members are not the only ones affected. Express Scripts spokesman Brian Henry said his company also manages prescription drug programs that cover some members of Anthem Blue Cross in California and some members of the SCAN Health Plan, a Medicare Advantage Organization.

In all, Express Scripts is linked with about 5 million health care beneficiaries in California, Henry said.

Walgreen spokesman Michael Polzin said it failed to reach an agreement with Express Scripts for a number of reasons, but that a main problem was Express Scripts wouldn't pay adequate drug reimbursement rates.

"They wanted to cut our reimbursement rates to a level that is below the industry average cost to provide each prescription," Polzin said.

Express Scripts is hired by health or insurance plans to administer pharmacy benefits, however, it and its 2,200 clients nationwide have an expectation that it keep costs low and quality high, Henry said.

"Walgreens wanted to be paid a premium for what it does, which is basically the same as other pharmacies," Henry said. "Our clients expect us to drive prices down."

Express Scripts clients can go to another of the 56,000 other pharmacies in its nationwide network, Henry said.

"On average, there is another pharmacy within half a mile of their Walgreens," he said.

Walgreen had other problems with Express Scripts, Polzin said.

"They wanted to unilaterally define contract terms, like what is a generic vs. a brand name," Polzin said.

Henry said Walgreen was the one that wanted to define contract terms, such as separating TRICARE members from Express Scripts' commercial clients.

"We wanted to separate our negotiations for their commercial business and their TRICARE business because we didn't want the military to be caught in the middle of this dispute," Polzin countered. "They refused to do that. We've done just about everything we can to continue serving the military and keep them out of the dispute."

TRICARE spokesman Austin Comacho said he didn't think Walgreen's exit would have a major impact on members. Many members are choosing mail delivery of prescriptions, which is run by Express Scripts. Members also can go to other pharmacies.

"A fair number of our beneficiaries live on or near military installations," he said. "Many of them prefer to go to the pharmacy on base." Naval Base Ventura County has a pharmacy.

Polzin said he thinks Express Scripts' motive is to push more clients toward its mail order pharmacy.

But health care costs are soaring, and Express Scripts was hired to negotiate the best deals possible, Comacho said.

"Some commercial carriers require that you use the mail order system because it saves them money," Comacho said. "Health care is a big slice of the defense budget, and pharmacy is a big slice of health care."

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