Millions of Americans depend on Medicare and Medicare Advantage for quality and comprehensive health care coverage. With an aging American population, the number of people eligible for Medicare will increase in the coming years — adding taxpayer cost to the popular program and taking up a significant portion of total Federal spending. In fact, nearly 10,000 people become eligible for Medicare each day. It’s estimated that the number of Medicare eligible people will grow from 67 million people today, to 72 million people by 2025. It’s incumbent upon everyone to protect the future of this important benefit.
As a pharmacy benefits manager (PBM), Express Scripts builds standard pharmacy networks to balance a consumer’s convenient access to prescription medicines with affordability. Clients choose the networks that work best for them and the unique needs of their employees and populations based on geography, demographics, and other key factors. We work to create flexible pharmacy network options – from large chain pharmacies to regional pharmacies to independent pharmacies and home delivery – that help ensure members can easily access the medications they need, when and where it’s most convenient.
Medicare is the largest public payer for drugs and has experienced high spending and increased prices on some drugs. Sometimes, a PBM like Express Scripts, will be forced to take a hard position with a pharmacy, when we know the outcome of a negotiation will not benefit the people who depend on us. Recently, we had this happen with AlignRx, a Pharmacy Services Administration Organization (PSAO). We made a good faith offer to AlignRx PSAO to continue our longstanding relationship concerning Medicare Part D participation. The terms of our offer would not pass higher costs onto Medicare, taxpayers, and ultimately Medicare customers. Unfortunately, AlignRx PSAO has declined to participate in any of Express Scripts’ Medicare Part D Performance Networks for the 2024 plan year.
We believe robust pharmacy networks are critical to ensuring access for Medicare customers and that individual pharmacists deserve the opportunity to make the decision that’s best for their business. As a result, we will offer the 1,563 independent pharmacists under AlignRx PSAO the opportunity to continue to participate in the same Medicare Part D networks they currently participate in, at standard terms and conditions with direct contracts. In addition, we’ll continue to contract directly with the 1,467 independent pharmacies comprising the legacy Pharmacy Providers of Oklahoma (PPOk) that have continued their direct agreements with Express Scripts following the creation of AlignRx in 2021.
We’ll welcome AlignRx PSAO back into our Medicare Part D Performance networks at any time if they decide to do what is right for our shared customers and accept the standard terms and conditions for participation that are being offered to all similarly situated providers and PSAOs – but we won’t stand by and allow our customers (and taxpayers) to pay more for their prescription medicines at a time when they can least afford it.
While we don’t expect any disruption for our customers, Express Scripts has a strong pharmacy network ready to support you. If needed, we’re ready to help you find another convenient pharmacy to fill your prescriptions. Medicare customers may call (866) 529-4917 for assistance 24 hours a day, 7 days a week. TTY users call: (800) 899-2114.
To learn more about PBMs and how they help you, click here.