ESI Repeats Solicitation for 2023 Tricare Network

Dec. 1, 2022

ESI Repeats Tricare Solicitation

With No Boost in Reimbursement

Express Scripts Incorporated (ESI) has sent out a new Tricare network enrollment alert with a Dec. 16 response deadline. If your pharmacy does not wish to participate in the 2023 Tricare network, no response is needed. If you elect to participate in the network for next year, you must respond to ESI by Dec. 16.

It is our understanding that the rates of reimbursement offered by ESI in this latest solicitation are the same that the PBM offered in July. The new solicitation notes that the Kroger Company grocery chain has terminated its relationship with ESI, removing its 2,256 pharmacies from the Tricare network. We believe that Kroger's withdrawal, along with that of other chains and independents, may have reduced Tricare patients' access to network pharmacies, prompting the new ESI solicitation.

Please be sure to carefully review ESI's proposed rates of reimbursement for both generic and brand drugs 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.

Some of our members consider the proposed ESI reimbursements rates to be oppressively low. You should carefully evaluate the offer and make your own conclusion.

Evaluating the ESI Offer

RxCompass -- our powerful data metrics platform -- has some very insightful reports that you can use to help evaluate the reimbursement terms under ESI's 2023 Tricare contract:

Patients by Plan Report

This report provides a list of patients with Rx claim activity
Location: Transactional Reports > Patient
Recommended report parameters:
Use a timeframe of year to date
Select the desired BIN/PCN/Group combination(s) (3 separate parameters)
Click ‘View Report’
Both patient and Rx volume are displayed once the report loads
Click the + to the left of the pharmacy name to drill down for individual patient detail
Click the blue hyperlink for further detail
Click the ‘Back’ hyperlink to return to the parent report, NOT the back button on your browser

Reimbursement Rate Report

This report summarizes plan performance
Location: Transactional Reports > Dispensing
Recommended report parameters:
Use a timeframe of year to date
Select the specific BIN/PCN/Group number
Date Type: Fill Date
Financial Implication: Financially Relevant
Formulation Type: Brand, then Generic
Run the report twice to see brand and generic performance separately
Select both to see aggregate performance
Click ‘View Report’
Once the report loads, use the search field above the column headings to search for specific BINs
Evaluate plan performance with metrics shown and note the volume of distinct patients
Click the blue hyperlinks for more detail; click the ‘Back’ hyperlink to return to the parent report, NOT the back button on your browser
Reminder: Transactional reports provide point of sale insight only (i.e., pre-rebate).

Known Tricare Plan Identifiers:

BIN: 003858
PCNs: A4, SC
Note: Per ESI, use SC when secondary to Medicare D only.
Group: DODA or TRRX