SFR submitted to Senate Armed Services Subcommittee on Personnel hearing.
The American Legion believes the nation’s national security is upheld by maintaining a robust and well-funded TRICARE Pharmacy Program – one of the most vital and frequently utilized benefits within the Military Health System.
The best ways to maintain that program were the subject of a Statement for the Record (SFR) submitted by American Legion National Security Division Deputy Director Ariel DeJesus Jr. The SFR was part of the House Armed Services Committee Subcommittee on Personnel July 15 hearing, “TRICARE Pharmacy Program.” DeJesus stressed the importance of the pharmacy and how much it can play a role in the quality of life for the servicemembers its is intended to assist.
“Access to affordable, timely, and high-quality prescription medications is essential to maintaining military readiness, managing chronic and acute medical conditions, and supporting behavioral health,” DeJesus wrote. “Ensuring access would improve the overall quality of life for active-duty servicemembers, National Guard and Reserve personnel, military retirees, survivors. The American Legion has long advocated for policies that preserve beneficiary access, affordability, and choice while ensuring the TRICARE Pharmacy Benefit continues to meet the evolving healthcare needs of the military community.”
The American Legion’s BASE (Base Assessment and Servicemember Experience) program – which has seen American Legion national staff and volunteers visit multiple military installations to engage with base leadership and personnel, civilian contractors and health-care professionals, and military families – also has provided insight into the pharmacy program.
“During our visits, Legion representatives identified pharmacy-related challenges, including staffing shortages, specialty medication availability, prescription fulfillment delays, continuity of care during permanent change of station moves, and barriers affecting beneficiaries in rural and overseas locations,” DeJesus noted. “These firsthand observations reinforce the need for continued congressional oversight of the TRICARE Pharmacy Program to ensure that future pharmacy network changes enhance, not diminish, beneficiary access, preserve patient choice, strengthen contractor accountability and deliver the high-quality pharmaceutical care earned by those who serve our nation.”
In the SFR, the Legion called the pharmacy program a vital element of military readiness, force health protection, and the long-term health and well-being of servicemembers, retirees, survivors and their families. “Access to timely, affordable, and clinically appropriate prescription medications is essential for preventing and managing chronic disease, treating acute illnesses and injuries, supporting behavioral health, and ensuring continuity of care throughout a beneficiary's lifetime,” DeJesus wrote. “For many military families, the pharmacy benefit is the most frequently utilized component of TRICARE and serves as a critical link between healthcare providers and successful patient outcomes. The American Legion maintains that decisions affecting pharmacy access should be viewed through the lens of readiness, beneficiary health, and continuity of care—not solely as opportunities for cost savings.”
DeJesus pointed to two American Legion resolutions that support the organization’s position:
· Resolution No. 102, which rejects shifting the cost of earned healthcare benefits onto military beneficiaries through higher fees or pharmacy copayments.
· Resolution No. 85, which recognizes accessible, high-quality healthcare as a fundamental quality-of-life issue that directly affects recruitment, retention, readiness, and family resilience.
“Collectively, these and other healthcare resolutions affirm The American Legion's commitment to protecting the earned healthcare benefits of those who have served by preserving beneficiary choice among Military Treatment Facility pharmacies, the TRICARE Retail Pharmacy Network, and the TRICARE Pharmacy Home Delivery Program,” wrote DeJesus.
The Statement for the Record also shared the Legion’s concerns that recent cuts in the TRICARE Retail Pharmacy Network have been driven, in part, by longstanding concerns from retail pharmacies regarding reimbursement rates, pharmacy benefit manager (PBM) contracting practices and rising operating costs. The Defense Health Agency (DHA) reduced the required minimum retail pharmacy network from 50,000 to 35,000 pharmacies, resulting in a reduction of more than 13,000 participating retail pharmacies between 2022 and 2024.
Pharmacy organizations also have consistently reported that reimbursement under the Fifth-Generation TRICARE Pharmacy Contract often fails to adequately cover medication acquisition costs, dispensing expenses, staffing and other operating costs; concerns also have been raised about limited transparency in pharmacy benefit manager (PBM) reimbursement methodologies, burdensome administrative requirements, and contract terms that provide little flexibility for pharmacies to negotiate sustainable participation.
“These financial and operational pressures have contributed to the withdrawal of thousands of retail pharmacies from the TRICARE network, particularly independently owned pharmacies that serve rural and medically underserved communities,” DeJesus wrote. “The reduction in the number of participating pharmacies has had a direct impact on many TRICARE beneficiaries. Although the Defense Health Agency has stated that statutory geographic access standards continue to be met, The American Legion has received numerous inquiries from beneficiaries whose trusted local pharmacies are no longer part of the TRICARE network, requiring them to travel significantly farther to obtain prescription medications. These changes have placed an added burden on aging retirees, beneficiaries with mobility limitations, caregivers, and those living in rural communities with limited pharmacy options.
“Additionally, many older beneficiaries may be unable or unwilling to rely on mail-order pharmacy services, making access to a local retail pharmacy essential for maintaining continuity of care. The American Legion is troubled that increased travel distances, reduced operating hours, higher prescription volumes at remaining pharmacies, and disruptions in established pharmacist-patient relationships may negatively affect medication adherence and health outcomes.”
The SFR noted that the Legion believes every TRICARE beneficiary should have timely access to affordable prescription medications through a robust and sustainable pharmacy network that supports military readiness, beneficiary health and long-term quality of life – regardless of age, mobility. Congress should require the Department of Defense (DoD) to ensure adequate access to pharmacies, strengthen oversight and preserve beneficiary choice, DeJesus shared.
The Legion’s Statement for the record also stressed the importance of DoD to conduct annual reviews of TRICARE’s contracts and provide data and audits to Congress, calling such oversight crucial for the transparency of taxpayer resources used effectively for their intended purpose of allowing servicemembers, veterans and military families to access prescription medications in a timely manner.
“TRICARE’s largest pharmacy contractor, Express Scripts, is the largest pharmacy benefit manager in the United States, managing the TRICARE pharmacy mail-order program and a retail pharmacy network,” DeJesus wrote. “Since 2022, Express Scripts’ management of TRICARE's retail pharmacy network has forced approximately 400,000 active-duty and retired military families to find a new in-network pharmacy after more than 13,000 retail pharmacies exited the network.
“Additionally, Express Scripts reportedly charges the DoD, on average, $484 more to dispense generic drugs through mail-order pharmacies Express Scripts owns than through competing pharmacies. This contractual arrangement gives Express Scripts an incentive to overcharge TRICARE patients and funnel them to its pharmacies.”
The SFR stated that auditing contractor data will lead to ensuring TRICARE beneficiaries have reliable, uninterrupted access to prescription medications they need. To ensure that these audits are completed periodically, DoD must provide audit reports to Congress to promote transparent oversight of TRICARE’s pharmacy contract.
The Statement for the Record also touched on beneficiary choice and affordability, as well as overseas pharmacy access. Read the entire SFR here.
- Legislative