NCPA calls out Express Scripts in letter 

ALEXANDRIA, Va. - The National Community Pharmacists Association is pushing Cigna’s Express Scripts, Inc. (ESI) to revise contract terms to align with its obligation to offer “reasonable and relevant” terms and conditions for participation in a Medicare Part D pharmacy network. The association is also asking Express Scripts to revise its “bonus pool fee” to align with federal policy. “We cannot help but note that Cigna-Express Scripts has publicly announced a desire to work with independent pharmacies and has even formed an Independent Advisory Committee in the last year,” NCPA CEO B. Douglas Hoey, pharmacist, MBA, wrote in a letter to Adam Kautzner, president of ESI, and David Cordani, chairman and CEO of the Cigna Group. “Unfortunately, and ironically, business conditions dictated by ESI to independent pharmacies have only gotten worse since ESI’s announcements – especially regarding Medicare Part D terms that our members tell us are out of market relative to Cigna-ESI’s competitors.” In the letter, Hoey details: 

• How ESI is continuing to pay pharmacies at rates that are less than their cost to acquire prescription medicines in Part D, violating federal law and guidance related to “reasonable and relevant” terms and conditions for participation in a pharmacy network 

• How bonus pool deductions are pharmacy price concessions that are not transparent at the point of sale. Instead, the deductions show up in bulk (not claim-by-claim) on the 835-payment file, also known as the Electronic Remittance Advice. The association says this appears to be in violation of the CMS rule that requires all pharmacy price concessions to be accounted for at the point of sale. 

Hoey’s letter follows a NCPA survey of independent pharmacy owners/managers in which almost half said that ESI was the PBM causing the most financial stress in Part D.