Cuts in Government Pharmacy Network Leave Patients with Fewer Options and Higher Prices

The Federal government has demanded a 33% reduction in its pharmacy network. Department of Defense leadership instructed ESI to eliminate over 15,000 pharmacies from its current network. This explains the below market offer that most PSAOs received for 2023.

Pharmacies directly contracted with Express Scripts, Inc (ESI) were purposely not offered participation in this network for 2023. It is beyond unconscionable for the federal government to target community pharmacies in this severe restriction of provider access. This is a gross misuse of federal tax dollars paid by the very businesses being excluded. 

The network rates offered to community pharmacies would have resulted in below-cost reimbursement with the average loss per script about $7.27. Even after intense negotiations, it was clear there was no intention of maintaining broad access to community pharmacy.

CURRENT STATUS

• ESI sent mass communications to patients notifying of the loss of pharmacy access. 

• ESI accelerated implementation of the restricted access network to be effective October 24, 2022. 

• The men and women of our armed forces and their dependents will no longer be able to use the pharmacy of their choice.

WHAT DOES THIS MEAN?

• Because of below-market reimbursements community pharmacies may have to turn away patients or increase their prices.

• Cuts like this make it almost impossible for locally owned, independent pharmacies to compete against big chains.

ACTION

• Numerous state and national pharmacy associations are working diligently to address this issue, and to ensure independent community pharmacies are not being discriminated against.

• Bretton Walberg, owner of 11 Walberg Family Pharmacies and Care-Fill medication packaging has reached out to Congressman Mike Kelly and Senator Michelle Brooks.

WE ENCOURAGE YOU TO CONTACT FEDERAL OFFICIALS AND FILE A COMPLAINT

President Joe Biden https://www.whitehouse.gov/contact/

Governor Tom Wolf https://www.governor.pa.gov/contact/

Members of the House https://www.legis.state.pa.us/cfdocs/legis/home/member_information/mbrList.cfm?body=H&sort=district

Pennsylvania Senators https://www.legis.state.pa.us/cfdocs/legis/home/member_information/mbrList.cfm?body=S&sort=district