The TRICARE retail pharmacy network cuts that occurred in late 2022 meant hundreds of thousands of beneficiaries lost their pharmacy, while at least 98,000 of those were left without a single network pharmacy that meets TRICARE access standards for driving distance, a recent report found. 

The Government Accountability Office’s Feb. 13 report into the TRICARE pharmacy program fulfilled a MOAA-supported requirement in the FY 2024 National Defense Authorization Act – a key part of our 2023 Advocacy in Action campaign stressing the importance of preserving the pharmacy benefit in the face of a shrinking network. 

Trouble started in October 2022, when TRICARE’s retail pharmacy network shrunk nearly 25%, losing nearly 15,000 locations. Reduced network requirements within the new pharmacy contract (TPharm5) allowed Express Scripts, the TRICARE pharmacy benefit manager, to shrink the network.

The minimum number of retail network pharmacies under the previous contract (TPharm4) was 50,000. TRICARE dropped that number to 35,000 for TPharm5. As a result, the TRICARE retail network lost nearly 25% of its retail locations, most of them independent or community pharmacies. 

[RELATED: Kroger Rejoins TRICARE Retail Pharmacy Network]

As stated in the GAO report, DHA officials said a smaller network would enhance the contractor’s ability to negotiate lower reimbursement rates with retail pharmacies, which could result in government savings. 

MOAA sought the GAO requirement in the FY 2024 NDAA to show Congress the impact of network cuts on military families.  

GAO reports the number of beneficiaries who don’t have a pharmacy within distance-based access standards grew by 55% from 177,000 under TPharm4 to 275,000 under TPharm5. At least 98,000 more beneficiaries were outside of the distance-based access standard compared with the period prior to the network cuts. These beneficiaries now face barriers to prescription medication access not because they live in pharmacy deserts, but because their local pharmacies have been cut from the network. 

GAO did not quantify other impacts not reflected in the driving distance access standard – such as the number of long-term care residents who lost the pharmacy that supplies their facility or the special services and niche locations (e.g., hospital lobbies) no longer available to TRICARE beneficiaries. However, GAO did report that 380,000 beneficiaries lost their pharmacy during the initial cuts in 2022.

From November 2022 through January 2023, an additional 2,484 pharmacies left the TRICARE retail pharmacy network, resulting in about 300,000 beneficiaries needing to find a new pharmacy. Data is not available to determine if some of these beneficiaries were the same as those affected in October 2022. Therefore, GAO was unable to determine the exact number of unique beneficiaries affected when DHA reduced the minimum required number of pharmacies.

Sharing Your Story 

MOAA requested this report because data was needed to quantify the impact of pharmacy network cuts –  but hearing from military families is still essential.  

[TAKE ACTION: Share Your Pharmacy Access Story With MOAA] 

Two years ago, hundreds of MOAA members and others shared their pharmacy access issues through our Legislative Action Center, offering real-world fallout from the loss of nearly 15,000 pharmacies (about 25% of the entire network). Stories included: 

• Rural veterans facing long drives and uncertain availability in search of critical medication. 

• Older veterans with special medication needs and limited transportation options, including those navigating post-surgery medical needs or in a long-term care facility. 

• Veterans who lost established relationships with local, independent pharmacies who left the TRICARE network and have faced not just longer drives, but a lower level of customer service from larger, unfamiliar chains. 

Have you struggled to fill prescriptions in the TRICARE network in recent months? Have you been forced to change pharmacies, dealt with drug shortages, or faced issues with specialty medications? Let us know about your experience; only through these details from beneficiaries can MOAA provide a full picture of the impact of TRICARE network changes to elected officials on Capitol Hill as we advocate for a reversal of retail network cuts. 

Keep up with the latest on this issue and others via MOAA’s Advocacy News page.