PUTT Blog | Senate Armed Services Presses ESI Over TRICARE as House Oversight Advances H.R. 6610 Pharmacists Fight Back Act in FEHBP

Two significant developments this month put questionable PBM practices squarely before Congress: the Senate Armed Services Committee’s TRICARE pharmacy benefits hearing  on July 15, and House Oversight Committee’s mark up and approval of H.R. 6610, the Pharmacists Fight Back Act in Federal Employee Health Benefits Plan (FEHBP), by a vote of 40-2.

Senate Hearing Examines TRICARE Pharmacy Benefits

The Senate Armed Services Committee convened on July 15 to examine pharmacy benefits under TRICARE, the health program serving military service members, retirees, and their families. The witness panel brought together officials from the Defense Health Agency; Express Scripts, TRICARE’s contracted PBM; and the pharmacy community:

• Dr. Adam Kautzner, president of Express Scripts

• Dr. David Smith, representing the Defense Health Agency

• Dr. Micah Lansford, an independent pharmacy owner from Clovis, NM, whose pharmacy is situated near Cannon Air Force Base

• Greg Reybold, attorney and Vice President at American Pharmacy Cooperative, Inc. (APCI)

The hearing gave lawmakers direct testimony from both sides of the TRICARE pharmacy supply chain: the PBM administering the benefit and the independent pharmacies dispensing prescriptions to military families. Dr. Lansford's testimony offered committee members a firsthand account of how TRICARE reimbursement and contracting practices affect a community pharmacy's ability to serve TRICARE beneficiaries and why in the end his pharmacy could no longer accept the TRICARE contract. Greg Reybold offered perspective on the contract, often directing his testimony directly at Drs. Smith and Kautzner, as the officials ultimately accountable for the structure and execution of the TPharm5 contract (current TRICARE contract). You can read both Dr. Micah Lansford’s and Greg Reybold’s written testimonies here. You can watch the hearing here.

House Oversight Committee Advances H.R. 6610

Separately, the House Oversight Committee marked up and then voted to advance H.R. 6610, the Pharmacists Fight Back Act in FEHBP, by 40-2. The bill targets PBM practices within the Federal Employee Health Benefits Program (FEHBP), which covers federal employees, retirees, and their dependents. You can learn more about HR 6610 at PharmacistsFightBack.org.

The near-unanimous, bipartisan vote sends the bill forward in the legislative process and provides opportunities for inclusion in “package” bills typically organized toward the end of the year. H.R. 6610 does not yet have a Congressional Budget Score and is unlikely to be voted on as an individual bill on the House floor. APCI and PUTT organized a Coalition letter of support with 62 signers that included NCPA, American Pharmacies, Pioneer Institute, Minnesota Farmers Union, Global Healthy Living Foundation, Compliant Pharmacy Alliance Cooperative and several state pharmacy associations. You can read our Coalition letter here. You can watch the markup hearing here.

What's Next for TRICARE and Pharmacists Fight Back Act?

While neither action finalizes policy change on its own, there is still movement and plenty of action to take in the coming weeks. The House recently approved language for the National Defense Authorization Act that would require a third party to audit TRICARE’s pharmacy benefits program. The Senate failed to advance its proposed NDAA language but vowed to try again before the August recess. H.R. 6610, having cleared a significant hurdle, faces its next procedural steps including CBO scoring, but proponents are now beginning to focus on H.R. 6609, the Pharmacists Fight Back Act in Medicare and Medicaid, assigned to the House Energy and Commerce Committee.  

We remain energized around these developments and will continue to push for meaningful PBM reform. Thank you to everyone who reached out to your Congressional Representative or Senator. Look for more information and opportunities to participate in pushing H.R. 6609 and 6610 forward, and for new developments in TRICARE coming soon!

Monique Whitney

PUTT Executive Director