Express Scripts Incorporated (ESI) is sending out a Tricare network enrollment alert via FAX to some of our members. The faxed alerts we have seen set a 15-day response deadline from the date the alert FAX is received. We do not know if ESI has communicated with all pharmacies by FAX or with some by other methods, and we do not know if the notifications were sent out to all Tricare pharmacies at the same time
The alert states that pharmacies must sign and return the contract offer to ESI within 15 days to enroll in the Tricare pharmacy network for 2023. Those that fail to do so will not be included in the 2023 network, ESI says, but will be given an opportunity to enroll in the network for 2024. If you have received this notification from ESI, please carefully note the sent date to determine your deadline for responding. Failure to sign and return the offer by that deadline means you will not be in the 2023 Tricare network.
The faxed notification specifies the rates of reimbursement for both generic and brand drugs for 2023. Please be sure to review these figures carefully to ascertain whether you wish to participate in the network for 2023, as the terms of reimbursement are different from ESI's past Tricare contracts.
The contract offer we have seen specifies that all claims will be reimbursed at flat rates rather than "effective rates" or averages across multiple drugs. In other words, every generic script covered under the contract would be reimbursed at the same flat (WAC - xx% + $x.xx) rate. All brand drugs would be reimbursed at a specified flat rate as well.
Some of our members report that the proposed ESI reimbursements rates are oppressively low. You should carefully evaluate the offer and make your own conclusion.