Episode Details

The PBM Reform Podcast, sponsored by APCI, welcomes John Vinson, PharmD, Chief Executive Officer of the Arkansas Pharmacists Association, for a timely conversation with host Greg Reybold about the management of the TRICARE pharmacy benefit.

Express Scripts administers pharmacy benefits for TRICARE, the Department of Defense healthcare program serving more than 9 million active-duty service members, military retirees, and family members. In fiscal year 2023 alone, TRICARE spent more than $8 billion on prescription medications.

Greg and John examine concerns surrounding Express Scripts’ administration of the program, including shrinking pharmacy networks, reduced patient choice, questionable contractor reporting, specialty-drug delivery oversight, and the consequences for independent and rural pharmacies.

A 2025 Government Accountability Office investigation found that:

• TRICARE’s minimum network requirement fell from 50,000 to 35,000 pharmacies.
• The network had approximately 13,165 fewer pharmacies in late 2024 than in late 2022.
• An estimated 380,000 beneficiaries may have been forced to find another pharmacy.
• The Defense Health Agency relied heavily on contractor-submitted reports that contained inaccuracies.
• DHA had not consistently audited the data used to evaluate beneficiary access.
• GAO’s two corrective recommendations remain open as of August 2026, although DHA has begun adding reporting and auditing requirements.

The episode also addresses higher 2026 prescription copayments. For most non-active-duty beneficiaries, home-delivery copays are now $14 for generic formulary drugs, $44 for brand-name drugs, and $85 for non-formulary medications. At retail network pharmacies, the corresponding 30-day copays are $16, $48, and $85.

Greg and John discuss whether PBM-driven network reductions represent true savings—or simply transfer costs, inconvenience, and access barriers to military families and the community pharmacies serving them.

• Express Scripts’ role in administering the TRICARE pharmacy benefit
• Pharmacy network contraction and beneficiary disruption
• Access challenges facing rural communities and military families
• Inaccurate contractor data and insufficient federal oversight
• Specialty-pharmacy delivery and monitoring concerns
• Rising 2026 copayments and pressure toward mail order
• Arkansas’ leadership in challenging PBM vertical integration
• The need for transparency, accountability, adequate reimbursement, and patient choice

Important clarification: TRICARE is administered by the Department of Defense and is distinct from healthcare and pharmacy services operated by the Department of Veterans Affairs.

Sponsored by APCI — American Pharmacy Cooperative, Inc.

Sources: U.S. Government Accountability Office, TRICARE’s 2026 pharmacy-benefit update, official 2026–2027 pharmacy costs.