A Washington pharmacy fight could hit Alaska's military families hardest

Alaska is one of the most military-heavy states in the country, and tens of thousands of service members, retirees, and their families here fill prescriptions through TRICARE, the military health plan. A fight playing out in Washington over how that pharmacy benefit is run could land harder in Alaska than almost anywhere else.

Here's why. TRICARE's pharmacy contract is run by Express Scripts, and when the company tightened what it pays pharmacies, roughly 13,000 of them nationwide — mostly small independents — dropped out of the network rather than lose money on every prescription. Those cuts hit rural families hardest, because rural towns often have no chain pharmacy to fall back on. In much of Alaska, the "nearest in-network pharmacy" isn't a 15-minute drive; it can be a plane ride. And the usual fallback, mail-order, is its own problem here: mail to remote communities is slow and unreliable, and some medications can't be shipped at all.

That's the backdrop to a Senate hearing Wednesday, where Express Scripts declined to voluntarily agree to an independent audit of its TRICARE contract. Sen. Elizabeth Warren pressed the company on contract language critics say could let it adjust what it pays pharmacies after the fact, and cited Defense Department data showing its mail-order option ran 12.5% more than retail for common generics. Express Scripts president Adam Kautzner said the company would comply with whatever Congress requires. Defense health officials defended the setup, saying the contractor earns a flat fee per prescription, can't profit from drug prices, and that the network still exceeds its required size.

The audit requirement is tucked into the 2027 defense bill — the same measure carrying billions for Alaska's bases that the Senate has yet to pass. For military families off Alaska's road system, it comes down to something concrete: whether the pharmacy they count on stays in the network, or they're left waiting on the mail.