Military-health drug problems getting worse, cancer clinics say – By Marty Schladen (The Columbus Dispatch) / March 9 2020
Community oncology clinics say that the military health system’s exclusive relationship with a giant corporation increasingly is putting them at a disadvantage. And that disadvantage is putting the health of veterans and members of the active-duty military at risk, the clinics say.
The Community Oncology Alliance again wrote to the U.S. Department of Defense last week to complain about Express Scripts, the nation’s largest pharmacy benefit manager. The department’s massive health program, Tricare, entered into an exclusive agreement in 2009 to allow Express Scripts to handle pharmacy reimbursements and other prescription-related matters.
But the multibillion-dollar company is using its dominant position in an over-concentrated marketplace to force cancer patients to use its own mail-order pharmacy, leading to long delays and mix-ups for patients receiving lifesaving drugs, said Ted Okon, executive director of the oncology alliance.
In one instance, he said, the program is giving preference to a $7,100-a-month prostate-cancer drug over one that costs $1,100 and that some doctors believe is more effective.
Mark Nelson, CEO of Northwest Medical Specialties in Tacoma, Washington, said his practice has a patient who was forced off the cheaper medication. He said the difference in cost wasn’t even the biggest problem.
“All these patients know is that the drug they’re on is keeping them alive,” Nelson said, describing repeated sessions clinic personnel had with the patient. “And then they’re being forced to switch.”
Okon said the method Express Scripts uses to take pharmacy business away from cancer clinics is simple. The company “is low-balling reimbursement rates for oral cancer drugs to oncology providers, both independent practices and hospital systems, such that it is impossible for them to provide these drugs as the reimbursement is less than the drug cost,” he said in his letter to Assistant Secretary of Defense for Health Affairs Thomas McCaffery.
“Express Scripts is low-balling reimbursement so that patients are forced to get their prescriptions filled by its specialty mail order pharmacy Accredo, which maximizes profits for Express Scripts.”
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