2023 -- S 0673

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LC002225

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2023

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S E N A T E   R E S O L U T I O N

RESPECTFULLY REQUESTING THE RHODE ISLAND CONGRESSIONAL DELEGATION

TO URGE THE UNDER SECRETARY OF DEFENSE FOR PERSONNEL AND READINESS

TO PROTECT PHARMACY ACCESS FOR THOSE WHO SERVE OR HAVE SERVED IN

THE ARMED FORCES

     Introduced By: Senators Ujifusa, Murray, Miller, Bell, Lauria, Zurier, Mack, Acosta,
Felag, and DiPalma

     Date Introduced: March 07, 2023

     Referred To: Senate Special Legislation and Veterans Affairs

     WHEREAS, TRICARE is the Department of Defense (DoD) health care program

administered by the Defense Health Agency (DHA) by means of the Military Health System for

approximately 9.5 million Military and their families; and

     WHEREAS, Part of the TRICARE health care program is the TRICARE Pharmacy

Benefits Program, authorized under 10 U.S.C. § 1074g and 32 C.F.R. 199.21; and

     WHEREAS, The TRICARE Pharmacy Benefits Program enables members of the U.S.

Military and their families to receive pharmacy benefits from not only military treatment

facilities, but also a network of civilian providers and pharmacies, including independent provider

practices, located in their own communities; and

     WHEREAS, DHA outsources the administration of the TRICARE Pharmacy Benefits

Program to a private corporation, currently Express Scripts, which is the second largest Pharmacy

Benefits Manager (PBM) in the nation by market share, managing approximately 25 percent of

all covered prescription drug claims; and

     WHEREAS, Express Scripts, which is owned by the insurer Cigna, owns a mail order

retail pharmacy, Accredo Health Inc., which operates Accredo Specialty Pharmacy; and

     WHEREAS, In 2022, DHA awarded Express Scripts a multi-year contract to serve as the

sole PBM to administer the pharmacy benefit offered to TRICARE beneficiaries after a bidding

process that involved only two submitted proposals; and

     WHEREAS, In order to participate as a network provider in the TRICARE Pharmacy

Benefits Program, providers must first have a contract with Express Scripts; and

     WHEREAS, Express Scripts’ duty to its shareholders is to maximize profits from the

DHA contract and this can conflict with the goal of providing the highest-quality health care to

the Military; and

     WHEREAS, In late July 2022, Express Scripts sent providers across the nation a new

TRICARE contract/network agreement for contract year 2023; and

     WHEREAS, Express Scripts required providers to execute and return the contract within

15 days of receipt, otherwise the providers were deemed to have declined participation for the

entirety of contract year 2023; and

     WHEREAS, Express Scripts has sent letters directly to Military personnel informing

them that as of October 24, 2022, they will no longer be able to get their medications from their

regular pharmacy provider. That includes Military patients with cancer who typically receive

their oral chemotherapy and related drugs at the point-of-care from their oncologists; and

     WHEREAS, In these same letters, Express Scripts directed TRICARE Military patients

with cancer to Accredo Health Group, which is a specialty pharmacy owned by Express Scripts

that provides mail order services only; and

     WHEREAS, In addition to Express Scripts’ efforts to limit patient choice and steer

patients towards its wholly-owned pharmacy, the new TRICARE contract contains unreasonably

low rates that are below pharmacists’ acquisition cost and/or otherwise unsustainable for both

brand and generic prescription drugs; and

     WHEREAS, Express Scripts is, in effect, forcing providers who wish to continue serving

TRICARE patients to operate at a guaranteed loss and shifting the insurance risk from Express

Scripts to the providers; and

     WHEREAS, As a result of these reimbursement terms, about 15,000+ providers from

across the nation, including a substantial percentage of community oncology and urology

providers, were no longer be able to serve TRICARE Military beneficiaries effective October 24,

2022; and

     WHEREAS, There are countless horror stories documenting that patients with cancer and

other serious diseases face delays, higher costs, and denials when subjected to receiving their

medications through the mail; and

     WHEREAS, Express Scripts is creating pharmacy “deserts” and is forcing Military to get

their drugs not from their local provider of choice, but from Express Scripts via the mail; and

     WHEREAS, The lack of oversight over Express Scripts’ provider network is precluding

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TRICARE Military patients with cancer from having access to a sufficient geographic

distribution of providers and violating TRICARE cancer patients’ rights to an adequate network

of providers with the capabilities to address their health care needs; now, therefore be it

     RESOLVED, That this Senate of the State of Rhode Island hereby respectfully requests

Senator Reed, Senator Whitehouse, Congressman Cicilline and Congressman Magaziner to urge

the Under Secretary of Defense for Personnel and Readiness Gilbert Cisneros to protect

pharmacy access for those who serve or have served in the armed forces, and work to ensure:

     1. Better monitoring of current and future retail pharmacy participation in the TRICARE

Pharmacy program;

     2. Expansion of the TRICARE network of pharmacies and care providers so there is

improved access to in-person pharmacy services for TRICARE beneficiaries; and

     3. PBM practices and finances do not discriminate against independent pharmacies; and

be it further

     RESOLVED, That the Secretary of State be and hereby is authorized and directed to

transmit duly certified copies of this resolution to the Clerk of the United States House of

Representatives, the Clerk of the United States Senate, and to members of the Rhode Island

Congressional Delegation.

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