Doris Spatz takes a once-a-day pill, Kisqali, to keep her metastatic breast cancer in check. As a patient in the Defense Department health system, she can fill routine prescriptions at a military pharmacy without a copay but also has the option of using a regular pharmacy through Tricare, the Defense Department’s private health care program.
Spatz found a local pharmacy in her Alexandria, Virginia, neighborhood and was getting the life-preserving medicine there.
That is, until Oct. 24, when Express Scripts, the pharmacy benefit manager for Tricare, dropped nearly 15,000 pharmacies from its network. Many of them were small, independent pharmacies, like Neighborhood Pharmacy of Del Ray, where Spatz was a customer.
That decision created problems, according to Doris’ husband, Dr. Michael Spatz, because the breast cancer drug is not carried by every pharmacy. And some larger chains require patients to use a branch of their business known as a specialty pharmacy for pricey or scarce medications for complex diseases.
“Express Scripts told us, ‘You can just go to CVS,’” Michael Spatz said. “But that was kind of a mess because you can’t just go into CVS and get a $1,500 medicine. You have to be in their special pharmacy system.”
About 27% of all pharmacies in the Tricare network are no longer covered, leaving more than 400,000 military beneficiari …