Advocacy News

TRICARE Beneficiaries to Lose Network Access to Home Infusion Pharmacies

Inconsistent and unclear policies create confusion and possible disruption for TRICARE beneficiaries

October 21, 2022

This fall, NHIA member pharmacies began reporting that TRICARE patients had received letters from Express Scripts (ESI) stating the local home infusion pharmacy they currently use will not be in network as of October 24, 2022, and instructing them that to avoid out of network expense premiums they should change their pharmacy to Accredo Pharmacy, a mail order pharmacy owned by ESI.

Upon review of the TRICARE online Specialty Care Drug List, it appears letters were sent to patients on home infusion drugs such as infliximab, ocrelizumab, and immune globulin, which are not listed on the TRICARE information page. These letters may be an oversight, or perhaps ESI is incorrectly applying its policies for oral and self-injectable medications to highly complex home infusion drug therapies.

NHIA also has reports from home infusion providers that sufficient notice was not provided regarding specialty network changes and opportunities for participation. Many providers stated they did not receive any notice, while others reported that they received notice for some commonly owned home infusion sites, but not others. Some reported signing and returning the notice within the short timeframe, but the patients they service are still receiving notices that they are no longer in network. Finally, for those that did receive notice, the timeframe given for home infusion providers to evaluate and respond was unreasonably short.

In response to these concerns, NHIA drafted a letter to the Department of Defense and Express Scripts with the following requests.

  1. Re-evaluate the decision to force members to utilize a single pharmacy or limited pharmacy network for any drug that requires IV or subcutaneous infusion through an access device, infusion pump, and/or that requires a nurse to administer.
  2. Review and clarify exactly which drugs are being included through retail and specialty home delivery and send a corrected communication to any patient using a product that is not on this list informing them of the error.
  3. Repeal any network pharmacy cancellations and re-issue a notice with a sufficient response period for participation.

NHIA has not received a response to the letter.

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