The new Tricare Retail Pharmacy program began nationwide operations with Express Scripts Inc. (ESI), St. Louis, Mo., on June 1st. Within hours, significant problems arose for all ESI customer accounts, including Tricare beneficiaries. The immediate and comprehensive efforts expended by ESI, private sector consultants, and Tricare experts resulted in restoration of commercial customer business and improvements for Tricare beneficiaries. System improvements continue daily and until all system errors and time-outs within the communications infrastructure are resolved, the Tricare Management Activity will provide updates on its website on a 72-hour basis.
According to Dr. William Winkenwerder Jr., assistant secretary of defense for health affairs, Our primary concern is that our beneficiaries receive the prescriptions they require. To that end, we continue to support efforts to resolve the problems. We apologize to our beneficiaries and the 53,000 pharmacies across the United States who have experienced the difficulties associated with these processing problems. Many people, from the network pharmacy staffs to the management of the pharmacy chains, to ESIs staff and consultants as well as our own Tricare staff, have actively engaged in sorting out the difficulties and implemented solutions to meet the needs of our beneficiaries. This dedicated effort continues.
Tricare and ESI expect that as initial prescription submission throughput improves, the program will stabilize and reach a steady and continuing pace. On June 7th and 8th, more than 180,000 claims were processed and paid each day. These numbers significantly exceed the standard of 125,000 Tricare claims usually processed and paid on Mondays and Tuesdays. Nevertheless, higher than normal rates of claims rejection continue and problems exist in some areas. The ESI provider-relations team is working with individual pharmacies and pharmacy chains alike to resolve both systems problems and the particular problems experienced by those pharmacies.
Barrett Toan, Express Scripts chairman and chief executive said, We fully recognize that this situation has been difficult for beneficiaries and pharmacies. We apologize to those who have been inconvenienced and commit to rapidly resolving the problems.
This new Tricare Pharmacy program introduces a standard, national approach to retail pharmacy use that offers Tricare beneficiaries the same benefit wherever they may be in the United States and its territories; it is a fully portable benefit. Beneficiaries who experience difficulty with their prescriptions during this initial period may contact the Tricare Retail Pharmacy (TRRx) Customer Service Center at (866) 363-8779. For those who purchased their medications at full price, they may file a paper claim (DD Form 2642, available on the Tricare Website: http://www.tricare.osd.mil/ ) to:
PO Box 66518
St. Louis, Mo. 63166-6518
Express Scripts Inc. is one of the largest pharmacy benefit management companies in North America, providing pharmacy benefit management services to more than 50 million members through facilities in 13 states and Canada. Express Scripts serves thousands of client groups, including managed care organizations, insurance carriers, third-party administrators, employers and union-sponsored benefit plans. Express Scripts Inc. has the ability to process in excess of one million claims daily.