June 27, 2024

Warren, Carter, Rounds, Welch, Lawmakers Slam Pharmacy Benefit Manager Express Scripts for Harming Service Members with Anti-Competitive Tactics

Warren, Carter, Rounds, Welch, Lawmakers Slam Pharmacy Benefit Manager Express Scripts for Harming Service Members with Anti-Competitive Tactics

Bipartisan, bicameral letter raises concerns about service member benefits and taxpayer costs, calls for DoD to revise or end contract with Express Scripts to protect servicemembers. 

“DHA’s exclusive contract with Express Scripts may be harming TRICARE members, independent pharmacies, and American taxpayers.”

Text of Letter (PDF)

Washington, D.C. — U.S. Senators Elizabeth Warren (D-Mass.), Mike Rounds (R-S.D.), Peter Welch (D-Vt.), U.S. Representative Buddy Carter (R-Ga.), and 20 other lawmakers sent a letter to Assistant Secretary of Defense for Health Affairs Dr. Lester Martinez-Lopez and Director of the Defense Health Agency (DHA) Lieutenant General Telita Crosland, raising concerns over Express Scripts’ exclusive contract to administer TRICARE’s pharmacy program, the healthcare system for the military, retirees, and their families. 

Express Scripts – owned by Cigna – is the second largest pharmacy benefit manager (PBM) in the country, and also owns its own mail-order pharmacy, Accredo. With this structure, Cigna owns multiple stages of the supply chain, enabling Express Scripts to routinely leverage its exclusive contract with DHA to keep much of its business in-house, steering TRICARE members to its mail-order pharmacy while disadvantaging competitors – including rural, independent pharmacies that servicemembers and their families rely on. 

For example, in August 2022, Express Scripts offered independent pharmacies such poor contract terms that nearly 15,000 pharmacies left the TRICARE network, forcing hundreds of thousands of active-duty and retired military families to use Accredo, which is prone to delays and safety issues. 

“(The) exodus of independent and retail pharmacies can be catastrophic for TRICARE members, especially those with complex medical conditions who are ill-served by mail-order pharmacies,” wrote the lawmakers.

In addition to the well-documented harms on competing pharmacies and TRICARE beneficiaries, the lawmakers are concerned that Express Scripts may be leveraging its exclusive contract to overcharge taxpayers, as vertically integrated PBMs routinely mark up drug prices to pad their bottom lines. In fact, a Wall Street Journal investigation found that Express Scripts charged commercial insurers over 27 times more for a selection of generic specialty drugs at Accredo compared to Cost Plus Drugs, an independent pharmacy the Wall Street Journal used as a baseline. 

“Express Scripts may be employing (anticompetitive) tactics to overcharge TRICARE –  a taxpayer-funded program – for drugs dispensed at Accredo, leveraging its TRICARE contract to underpay competitors and overpay its related companies,” wrote the lawmakers. “For these reasons, we believe DHA’s exclusive contract with Express Scripts may be harming TRICARE beneficiaries, independent pharmacies, and American taxpayers.”

The letter is also signed by U.S. Representatives Robert Aderholt (R-Ala.), Rick Allen (R-Ga.), Rebecca Balint (D-Vt.), Stephanie Bice (R-Okla.), James Comer (R-Ky.), Donald Davis (D-N.C.), Madeleine Dean (D-Pa.), Neal Dunn (R-Fla.), Mike Flood (R-Neb.), Diana Harshbarger (R-Tenn.), Henry Johnson (D-Ga.), Jennifer Kiggans (R-Fla.), Mariannette Miller-Meeks (R-Iowa), Ralph Norman (R-S.C.), Katie Porter (D-Calif.), John Rose (R-Tenn.), Adrian Smith (R-Neb.), Abigail Spanberger (D-Va.), Claudia Tenney (R-N.Y.), and Bruce Westerman (R-Ark.).  

Senator Warren has led the fight for affordable health care and fair practices in the health care industry:

  • In June 2024, Senator Warren wrote to the Department of Justice (DOJ), the Department of Health and Human Services (HHS), and the Federal Trade Commission (FTC), calling out high health care costs due to vertically-integrated insurers, private equity companies, and pharmaceutical companies that are driving health care consolidation. 
  • In March 2024, Senators Warren and James Lankford (R-Okla.) sent a letter to Majority Leader Chuck Schumer (D-N.Y.) and Minority Leader Mitch McConnell (R-Ky.) to call for immediate action on reforming PBMs in an effort to reduce the cost of prescription drugs. 
  • In November 2023, Senators Warren and Mike Braun (R-Ind.) sent a letter urging the Department of Health and Human Services (HHS) Inspector General to determine if vertically-integrated health care companies are hiking prescription drug costs and evading federal regulations.
  • In November 2023, Senator Warren sent a letter to Federal Trade Commission (FTC) Chair Lina Khan and Commissioners Bedoya and Slaughter expressing disappointment with the FTC’s proposed consent order allowing pharmaceutical giant Amgen to move forward with its acquisition of Horizon Therapeutics (Horizon) and urging the FTC to reject the use of behavioral and structural remedies going forward. In the letter, Senator Warren underscored FTC’s responsibility to hold Big Pharma accountable and protect competition and access to pharmaceutical products, given concerns that deals such as this one could raise the price of medicine.
  • In October 2023, U.S. Senator Warren and Representative Pramila Jayapal (D-Wash.) sent a letter to the Department of Justice (DOJ) Antitrust Division and the Federal Trade Commission (FTC), urging them to carefully scrutinize UnitedHealth Group’s (UHG’s) pending acquisition of Amedisys. The lawmakers urged the agencies to scrutinize similar deals, reject behavioral or structural remedies, and oppose any health care acquisition that would threaten competition, increase prices, and reduce quality of care. 
  • In September 2023, Senator Warren and Representative Becca Balint (D-Vt.), along with a bicameral group of lawmakers, submitted a public comment to the Federal Trade Commission (FTC) and the Department of Justice (DOJ) in support of the agencies’ proposed merger guidelines.
  • In June 2023, at a hearing of the Senate Finance Committee, Senator Warren raised concerns about how profiteering in Medicare Advantage (MA) is driving vertical consolidation in health care.
  • In March 2023, Senator Warren sent a letter to FTC Chair Lina Khan and Commissioners Alvaro Bedoya and Kelly Slaughter urging them to carefully scrutinize CVS Health Corp’s (CVS) pending acquisition of Oak Street Health, Inc (Oak Street).
  • In January 2023, Senator Warren sent a letter to Federal Trade Commission (FTC) Chair Lina Khan and FTC Commissioners Alvardo Bedoya and Rebecca Kelly Slaughter urging the agency to closely scrutinize two pending big pharmaceutical mergers: Amgen and Horizon Therapeutics, and Indivior and Opiant.
  • In March 2022, Senator Warren called out Big Pharma for price-gouging on prescription drugs and providing misleading information on their high drug prices.
  • In February 2022, Senators Warren, Angus King (I-Maine), and Congressman Lloyd Doggett (D-Texas) urged HHS to exercise march-in rights for life-saving cancer drug Xtandi to dramatically lower its price for millions of Americans. She also called out big pharma and insurance companies’ tricks to squeeze taxpayers and Medicare beneficiaries. And she called for passage of the Build Back Better Act, which includes provisions that could generate billions in savings and give the Department of Health and Human Services the authority to negotiate prices on some high-price drugs. 
  • In June 2021, Senator Warren led a letter questioning PhRMA's lobbying efforts to block policies that would lower drug costs for millions of Americans. 
  • At a Senate Finance Committee hearing in May 2021, Senator Warren called for trade negotiations that put patients over big pharma profits. 
  • Senator Warren has also introduced legislation that would radically reduce drug prices through public manufacturing of prescription drugs, including the Affordable Drug Manufacturing Act with Congresswoman Schakowsky. With Senator Shaheen, she introduced the End Taxpayer Subsidies for Drug Ads Act, legislation that would close a big pharma advertising loophole.