
David Smith
26:23 - 27:19
"DHA uses a pharmacy benefit administrator, or a PBA model, rather than a traditional pharmacy benefit manager, or PBM model, commonly used by many employers and health insurance firms. The defining feature of the PBA model is, is the DHA pays the contractor a fixed administrative fee per prescription filled at retail or TMAOP. The TPharm V contractor cannot generate revenue from price of drugs themselves at either retail or mail order outlet."
“DHA uses a pharmacy benefit administrator, or a PBA model, rather than a traditional pharmacy benefit manager, or PBM model, commonly used by many employers and health insurance firms. The defining feature of the PBA model is, is the DHA pays the contractor a fixed administrative fee per prescription filled at retail or TMAOP. The TPharm V contractor cannot generate revenue from price of drugs themselves at either retail or mail order outlet.”
Over 70% of all prescription medications are provided through either the mail order or the retail networks, which are managed by the Defense Health Agency through our TRICARE pharmacy contractor, Evernorth Federal Services. This contract is different. From most civilian models for administering prescription drug benefits, DHA uses a pharmacy benefit administrator, or a PBA model, rather than a traditional pharmacy benefit manager, or PBM model, commonly used by many employers and health insurance firms. The defining feature of the PBA model is, is the DHA pays the contractor a fixed administrative fee per prescription filled at retail or TMAOP. The TPharm V contractor cannot generate revenue from price of drugs themselves at either retail or mail order outlet.
A Senate Armed Services subcommittee hearing Wednesday put Express Scripts' 23-year TRICARE contract under sharp scrutiny, with Sen. Warren citing DOD data showing the contractor's mail-order pharmacy costs 12.5% more than retail for generic drugs, and the company's president declining to voluntarily submit to an independent audit.
