Grave Concerns for Tricare Beneficiaries
Floor Speech
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Mr. CARTER of Georgia. Mr. Speaker, during my Special Order today, my colleagues and I will express grave concerns about the impact that our servicemembers and their families are facing as a result of the Defense Health Agency's decision to proceed with Express Scripts pharmacy network contract.
We are going to address how TRICARE beneficiaries are no longer guaranteed access to their medication at their local pharmacy of choice. This decision by Express Scripts has severely impacted those who serve or have served our country honorably by reducing patients' access to quality healthcare.
We continue to hear from pharmacists and patients across the country who are expressing concerns about these changes.
Let's keep in mind that Express Scripts is currently under Federal investigation by the Federal Trade Commission for their role in increasing prescription drug costs and unfair and deceptive practices towards pharmacies.
Servicemembers and their families who rely on their local pharmacist for critical care, such as cancer treatments or knowledge of their medical history, are now forced to seek that treatment elsewhere.
It is our responsibility to ensure that their access to affordable, quality healthcare is not hindered.
The Biden administration has tools at their disposal to stop this, but instead, they are turning a blind eye.
Express Scripts, Inc., a pharmacy benefit manager, PBM, for the TRICARE program while serving as a mail-order and specialty pharmacy itself, made the pocket-lining move of reducing the number of TRICARE's in-network pharmacies by almost 15,000 last October.
Luckily, there are some businesses, like EPIC Pharmacy Network in my district, that decided to continue filling these prescriptions despite the loss.
On top of that, Kroger has announced that their pharmacies will no longer be able to serve TRICARE beneficiaries. As a result, hundreds of thousands of men and women of the United States Armed Forces, military retirees, and their families are at risk of losing access to necessary prescription drugs and treatment.
Since that date, beneficiaries in rural communities have been left with no local options for filling their prescriptions.
I used to own and operate a local pharmacy. In fact, I used to own and operate three local pharmacies. Understand that no matter how badly we want to help people, at the end of the day you are running a business, and that business needs to be profitable so that it can keep its doors open.
The sudden and wrongful reduction goes far beyond simply reducing access to care for TRICARE beneficiaries.
For those who need specialty medicines, the mail-order pharmacy used by Express Scripts threatens the medical integrity of the medicine and places the beneficiaries at risk of receiving the medications late, damaged, or missing.
Of greater concern, it eliminates the crucial role pharmacists play in protecting beneficiaries' health, especially those requiring multiple medications where contraindications are always a concern.
Overall, these pharmacy network changes will put servicemembers and their families at risk in receiving the prescription drugs and treatments they need.
These brave men and women dedicated their lives to defending our freedoms, and one of the things we promised them when they signed up is quality healthcare while they served and when they retired from the military, as well.
We are repaying them with a healthcare system that profits off of sick military personnel, family members and retirees.
Luckily, there are some businesses, like EPIC Pharmacy Network in my district, that decided to continue filling these prescriptions despite the loss. I applaud that decision, but they never should have been put in this position to begin with.
It is a pain for pharmacies, but it is detrimental to our military servicemembers and their families.
These brave men and women dedicated their lives to defending our freedoms. We are repaying them with a healthcare system that puts profits ahead of people.
I brought this to the attention of the Defense Health Agency back in October to discuss how we could restore local pharmacy access to these patients.
As a pharmacist myself, whose Congressional District is home to every single branch of the military and a large veteran community, I was dumbfounded by their response: No one cares about losing access to their local pharmacy? You have got to be kidding me.
It is one thing to make that claim to me; it is another to make it to the nearly 800 men and women who sent me their personal story detailing how losing access to their medicine is impacting their health and their well-being.
Hunter, a servicemember from South Carolina, saw the cost of his prescription go up by almost 600 percent after Express Scripts made changes to the TRICARE pharmacy program.
Is this how we want to treat our heroes who have given everything for our country, by increasing the cost of their medication by 600 percent? Seriously?
Or Jacqueline, who says this move ``has made the difference between stopping to get medicine on the way home or going an additional hour or more to the nearest base pharmacy before going home.''
For patients like James, a retired Air Force veteran, this move was more than just a frustration. It was a direct attempt to undermine small business. ``Why would the Federal Government choose large chains over supporting small businesses,'' he asks?
``In my neighborhood store, I am not just a number. The service I receive is far better than the big box pharmacies--once again, the large companies are trying to squeeze out the little ones. When will the Federal Government stop supporting this?''
It is time for the Biden administration to answer James' question or at a minimum the questions posed by a bipartisan coalition of legislators in the two letters I have led to the DHA on this issue.
I am mailing these stories to the White House because servicemembers and their families shouldn't be cut out of their own healthcare decisions.
I look forward to hearing from my Republican and Democrat colleagues about these issues.
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Mr. CARTER of Georgia. I thank Representative Harshbarger for her insightful comments. We are very fortunate to have her in Congress and very fortunate to have her representing the profession of pharmacist.
As she indicated, she understands firsthand the impact that this is having on patients. After all, she was on the other side of the counter for many years, just like I was.
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Mr. CARTER of Georgia. I thank the gentleman from Colorado.
If you will notice, one of the things that he pointed out and I pointed out earlier in my remarks, he represents a lot of veterans. He represents a lot of people who have retired in his district.
These military bases, many of our veterans, when they leave the service, they retire in the area where they have been serving.
That is certainly the case in my district, and I suspect it is the case in Representative Lamborn's district as well.
That is why this is having such a big impact on people. It has disrupted their lives. This is not just a cost-saving move here.
This move has impacted veterans who served our country, sacrificed for our country. It has impacted them and their families after we promised them we would give them quality healthcare, affordable healthcare, and yet, it has done just the opposite.
Thank you, Representative Lamborn, for your comments.
Mr. Speaker, at this time, I recognize a good friend of mine and a fellow member of my delegation who also represents an area with a heavy military presence and a heavy veteran presence in his district just north of my district.
I know that Fort Gordon is in his district, and I know that there are a lot of retirees and a lot of veterans who have retired in his district as well.
I yield to the gentleman from Georgia (Mr. Allen).
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Mr. CARTER of Georgia. I thank the gentleman for his comments.
I want to point out one thing that he so astutely pointed out, and that is about the rural areas. Keep in mind, now, yeah, they are still going to have a lot of the big box pharmacies that are going to be participating in this. They will still have the mail order, but there are a lot of rural areas that are going to be impacted here. A lot of our veterans live in rural areas.
Mr. Allen's district, like my district, has a lot of rural area in it. Our constituents are impacted by this.
Thank you for your comments.
Mr. Speaker, I want to point out one other thing. Express Scripts is one of three PBMs in this country that control 80 percent of the market.
That's right. Express Scripts is one of three PBMs in this country that control 80 percent of the market.
Now, of TRICARE, they have this contract. They control 100 percent of the people covered under this contract. But it is also important--we mentioned mail order, and mail order is a big component of this as well.
By the way, Mr. Speaker, Express Scripts PBM, guess who owns the mail order pharmacy that they are using? They do.
That's right. Express Scripts PBM, which is owned by Cigna Insurance, also owns the PBM and the mail order pharmacy.
So they are pushing these patients to their pharmacy. They are pushing them away from the independent retail pharmacy and pushing them to their mail order pharmacy.
And you wonder how they are going to save money?
Mr. Speaker, at this time, I recognize a new Member of Congress and a new member of the Doctors Caucus. We are delighted to have the Congresswoman from Virginia, Representative Jen Kiggans, as a member of our Doctors Caucus, and as a Member of our body. I invite her now to make comments on this as well.
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Mr. CARTER of Georgia. I thank the lady from Virginia for her very insightful comments. She, herself, a veteran. She, herself, a healthcare professional. She, herself, who has seen the impact that this has had on veterans and on their families.
The inconvenience, how they are having to travel further now to get their prescriptions, how they are having to pay more.
All of this after they served our country, sacrificed for our country, and now this is the way that we are going to repay them, by allowing a company that has as their motive profit to treat them this way?
Is that the way the Biden administration wants to handle this?
Is that what they want to allow?
I don't think so.
Mr. Speaker, at this time, I yield to the gentleman from Alabama (Mr. Moore). Another valuable Member of the United States Congress and a neighbor to my west. I ask him for his comments.
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Mr. CARTER of Georgia. Mr. Speaker, I thank the gentleman for his comments; they are insightful. He, like all of us, has constituents who have been inconvenienced and have been rudely and, quite honestly, just selfishly disrupted.
He mentioned the fact that people who have been using the same pharmacy for years, now having to find another pharmacy, all because of profits, all because this company, Express Scripts, is trying to make more money off the back of our veterans. We should be ashamed. This administration should be ashamed for letting this happen.
You hear it from me. You have heard it from some of my colleagues. I want to share with you just a couple of stories real quick; a story that was sent to me. I mentioned that we have heard from constituents, and we have.
A concerned citizen wrote and said, I have been using the same pharmacy since 1985, and now I have to change; no choice of my own, but now I have to change. My pharmacist knows my family's medical issues, and now I have to train a pharmacist pertaining to my medical history.
This is an example. Another one--and we are fixing to hear from a retired marine and general; but another one.
As a retired marine Master Sergeant who suffers from exposure to Agent Orange and Camp Lejeune water contaminates, my family has used a local pharmacy in our hometown of Broken Arrow, Oklahoma, for 25 years. Our pharmacist is not only a healthcare provider but is also a well- known friend and neighbor.
One of B.A. Family Drugs most prized services was free home delivery by their Drug Bug, a Volkswagen Beetle. We can no longer rely on that excellent service.
Again, this has disrupted people's lives. But it is more than just people; it is our heroes, our veterans.
At this time I want to recognize, as I mentioned earlier, one of our true American heroes, and one that I am honored to serve with in Congress, one of our--I believe it is four generals that we have here in Congress serving with us now, and that is Congressman Jack Berman from Minnesota.
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Mr. CARTER of Georgia. Mr. Speaker, I thank the gentleman for his service to our country and for his interest in this subject. It is extremely important, and we appreciate his leadership.
Mr. Speaker, again, I want to share with you some of the comments that we have gotten in our office. From Rick P: My neighborhood pharmacy is 5 minutes away and is the only one in town. But now, with changes, I have to go 30 minutes to and from the nearest pharmacy in the next town. That is not right. I have been going to the same pharmacy for 22 years, and they know my medical problems and prescriptions I take.
This is the way we are going to treat our veterans. This is the way we are going to treat our veterans' families.
From Bob S. In Gainesville: I am retired Air Force. My wife and I live in Gainesville, Georgia. We currently use Express Scripts mail order pharmacy, or VA mail order when possible. My wife has insurance through her employer which makes her ineligible for Express Scripts mail order. It also means she can only use three pharmacies that accept both insurance. We find-- Listen to this, Mr. Speaker. We find ourselves driving 3 hours one way so we do not have to pay $2,000 out of pocket each month for her medications. Now, with fewer pharmacies accepting TRICARE, we will probably have to make the trip more often.
Wow, what a promise we are keeping to these veterans. We are promising them that we are going to give them quality healthcare for their sacrifice, for their service to our country; and we are making them drive 3 hours, one way, so that they can save on the co-payment and won't have to pay $2,000 out of pocket. Ridiculous.
Another concerned citizen. I called to have a prescription refilled 2 weeks before I was out of my medication. However, my medication never came. I called Express Scripts to inquire about its status, and they told me that I had no refills. So I currently am out of medication, and per Express Scripts, I cannot get my medication for 2 to 3 weeks. How is this right? I have served my country for 30 years, and I cannot get my medication for 2 to 3 weeks?
What are we supposed to tell these people?
What are we supposed to tell our veterans?
Mr. Speaker, this is not acceptable. You don't want this. I don't want this. No Member of Congress wants to see this.
So why is it that the Department of Defense is not addressing this? Why aren't they responding to my letters? Why aren't they accepting my invitations to come to their office and talk to them about this?
Another concerned citizen. We live across the street from a locally run independent pharmacy. We strongly believe in supporting local businesses and having the choice of where we get our medical needs. Isn't that what America is supposed to be about? Please do whatever possible to keep our local pharmacy in the network. Local businesses, small businesses, are important to our communities.
Another concerned citizen: We live in a small town with only one pharmacy, which Express Scripts has quit doing business with. Our only other alternatives are pharmacies that are either 20 miles away or 10 miles away. With the price of gas, this just adds another expense to the already high cost of medication.
Bob P. writes: They removed our local pharmacy that was walking distance from our home. We now need to travel several miles for the next pharmacy on the very limited list. This was a surprise when they deleted so many pharmacies off the list.
On and on and on; all of these messages sent to our office. Why were they sent to our office? Because, obviously, they know I am a pharmacist. Obviously, they know I am working on this issue.
Mr. Speaker, this is despicable. No one should--no American should have to suffer through this, but especially our veterans who sacrificed for our country.
You see the comments back here. We depend on the Coast Guard to do search and rescue. They should be able to obtain their medications from their local pharmacy and pharmacist.
It is like the years of service I gave to this country are no longer appreciated. It is like us veterans are unimportant to this Nation.
Is that the message we want to send? No.
They will no longer have access to our free deliver service or access to a live pharmacist in a timely manner. It is sad, it is dishonest, and greedy on the part of Express Scripts for agreeing to this.
One last letter that we received. Our local independent pharmacy has expertly provided for us and have become like family. Our local neighborhood businesses are very important to community strength and solidarity and cutting them out further weakens the ties that help to keep communities strong and viable. Please strengthen families and communities by reinstating local and independent pharmacies.
That is why, currently, as we speak, the FTC, the Federal Trade Commission, is looking into the impact that the PBMs are having on local independent pharmacies; something that I asked them to do 8 years ago when I first entered Congress.
The first thing I did when I got to Washington, D.C., was to call the FTC and ask them to look at the vertical integration that exists in the drug pricing scenario, where the insurance company owns the PBM that owns the pharmacy.
That is right. Aetna owns Caremark, which owns CVS. Cigna owns Express Scripts PBM, which owns Express Scripts mail order. Then you have United--same thing.
Thank goodness, last summer, the FTC agreed to look at this vertical integration that has caused the prices of prescription drugs to go so high. There was a study done by the Berkeley Research Group last year. It showed, Mr. Speaker, that only 37 percent of the price of a medication goes to the pharmacy manufacturer, which begs the question: Where does the other 63 percent go?
Guess where it goes? It goes to the PBM, the middleman, to Express Scripts, those types of companies. That is where it goes.
Now, look, I am not opposed to anybody making money, but at the same time, tell me the value they are bringing to healthcare. They are not bringing any value to healthcare.
The egregious policies of the PBMs are what are causing prescription drug prices to go up, and now they are cutting out the local independent pharmacies, and now they are penalizing our veterans, causing them to have to drive miles and miles and do without their medication and pay higher prices all to make more profit.
Mr. Speaker, this is why we are here today. It is because of the patients. It is because of our veterans and their families. They are the ones that are suffering. They are the ones that need the Biden administration, who can do something about this and who should do something about this. They are the ones who need them to step up.
These stories should not be our brave servicemembers' reality. We can and must do better.
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