Rhode Island 2023 Regular Session

Rhode Island Senate Bill S0673 Compare Versions

Only one version of the bill is available at this time.

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5	5	2023 -- S 0673
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7	7	LC002225
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9	9	S TATE OF RHODE IS LAND
10	10	IN GENERAL ASSEMBLY
11	11	JANUARY SESSION, A.D. 2023
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14	14	S E N A T E R E S O L U T I O N
15	15	RESPECTFULLY REQUESTING THE RHODE ISLAND CONGRESSIONAL DELEGATION
16	16	TO URGE THE UNDER SECRETARY OF DEFENSE FOR PERSONNEL AND REA DINESS
17	17	TO PROTECT PHARMACY ACCESS FOR THOSE WHO SERVE OR HAVE SERVED IN
18	18	THE ARMED FORCES
19	19	Introduced By: Senators Ujifusa, Murray, Miller, Bell, Lauria, Zurier, Mack, Acosta,
20	20	Felag, and DiPalma
21	21	Date Introduced: March 07, 2023
22	22	Referred To: Senate Special Legislation and Veterans Affairs
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25	25	WHEREAS, TRICARE is the Department of Defense (DoD) health care program 1
26	26	administered by the Defense Health Agency (DHA) by means of the Military Health System for 2
27	27	approximately 9.5 million Military and their families; and 3
28	28	WHEREAS, Part of the TRICARE health care program is the TRICARE Pharmacy 4
29	29	Benefits Program, authorized under 10 U.S.C. § 1074g and 32 C.F.R. 199.21; and 5
30	30	WHEREAS, The TRICARE Pharmacy Benefits Program enables members of the U.S. 6
31	31	Military and their families to receive pharmacy benefits from not only military treatment 7
32	32	facilities, but also a network of civilian providers and pharmacies, including independent provider 8
33	33	practices, located in their own communities; and 9
34	34	WHEREAS, DHA outsources the administration of the TRICARE Pharmacy Benefits 10
35	35	Program to a private corporation, currently Express Scripts, which is the second largest Pharmacy 11
36	36	Benefits Manager (PBM) in the nation by market share, managing approximately 25 percent of 12
37	37	all covered prescription drug claims; and 13
38	38	WHEREAS, Express Scripts, which is owned by the insurer Cigna, owns a mail order 14
39	39	retail pharmacy, Accredo Health Inc., which operates Accredo Specialty Pharmacy; and 15
40	40	WHEREAS, In 2022, DHA awarded Express Scripts a multi-year contract to serve as the 16
41	41	sole PBM to administer the pharmacy benefit offered to TRICARE beneficiaries after a bidding 17
42	42	process that involved only two submitted proposals; and 18
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46	46	WHEREAS, In order to participate as a network provider in the TRICARE Pharmacy 1
47	47	Benefits Program, providers must first have a contract with Express Scripts; and 2
48	48	WHEREAS, Express Scripts’ duty to its shareholders is to maximize profits from the 3
49	49	DHA contract and this can conflict with the goal of providing the highest-quality health care to 4
50	50	the Military; and 5
51	51	WHEREAS, In late July 2022, Express Scripts sent providers across the nation a new 6
52	52	TRICARE contract/network agreement for contract year 2023; and 7
53	53	WHEREAS, Express Scripts required providers to execute and return the contract within 8
54	54	15 days of receipt, otherwise the providers were deemed to have declined participation for the 9
55	55	entirety of contract year 2023; and 10
56	56	WHEREAS, Express Scripts has sent letters directly to Military personnel informing 11
57	57	them that as of October 24, 2022, they will no longer be able to get their medications from their 12
58	58	regular pharmacy provider. That includes Military patients with cancer who typically receive 13
59	59	their oral chemotherapy and related drugs at the point-of-care from their oncologists; and 14
60	60	WHEREAS, In these same letters, Express Scripts directed TRICARE Military patients 15
61	61	with cancer to Accredo Health Group, which is a specialty pharmacy owned by Express Scripts 16
62	62	that provides mail order services only; and 17
63	63	WHEREAS, In addition to Express Scripts’ efforts to limit patient choice and steer 18
64	64	patients towards its wholly-owned pharmacy, the new TRICARE contract contains unreasonably 19
65	65	low rates that are below pharmacists’ acquisition cost and/or otherwise unsustainable for both 20
66	66	brand and generic prescription drugs; and 21
67	67	WHEREAS, Express Scripts is, in effect, forcing providers who wish to continue serving 22
68	68	TRICARE patients to operate at a guaranteed loss and shifting the insurance risk from Express 23
69	69	Scripts to the providers; and 24
70	70	WHEREAS, As a result of these reimbursement terms, about 15,000+ providers from 25
71	71	across the nation, including a substantial percentage of community oncology and urology 26
72	72	providers, were no longer be able to serve TRICARE Military beneficiaries effective October 24, 27
73	73	2022; and 28
74	74	WHEREAS, There are countless horror stories documenting that patients with cancer and 29
75	75	other serious diseases face delays, higher costs, and denials when subjected to receiving their 30
76	76	medications through the mail; and 31
77	77	WHEREAS, Express Scripts is creating pharmacy “deserts” and is forcing Military to get 32
78	78	their drugs not from their local provider of choice, but from Express Scripts via the mail; and 33
79	79	WHEREAS, The lack of oversight over Express Scripts’ provider network is precluding 34
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83	83	TRICARE Military patients with cancer from having access to a sufficient geographic 1
84	84	distribution of providers and violating TRICARE cancer patients’ rights to an adequate network 2
85	85	of providers with the capabilities to address their health care needs; now, therefore be it 3
86	86	RESOLVED, That this Senate of the State of Rhode Island hereby respectfully requests 4
87	87	Senator Reed, Senator Whitehouse, Congressman Cicilline and Congressman Magaziner to urge 5
88	88	the Under Secretary of Defense for Personnel and Readiness Gilbert Cisneros to protect 6
89	89	pharmacy access for those who serve or have served in the armed forces, and work to ensure: 7
90	90	1. Better monitoring of current and future retail pharmacy participation in the TRICARE 8
91	91	Pharmacy program; 9
92	92	2. Expansion of the TRICARE network of pharmacies and care providers so there is 10
93	93	improved access to in-person pharmacy services for TRICARE beneficiaries; and 11
94	94	3. PBM practices and finances do not discriminate against independent pharmacies; and 12
95	95	be it further 13
96	96	RESOLVED, That the Secretary of State be and hereby is authorized and directed to 14
97	97	transmit duly certified copies of this resolution to the Clerk of the United States House of 15
98	98	Representatives, the Clerk of the United States Senate, and to members of the Rhode Island 16
99	99	Congressional Delegation. 17
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