[Congressional Record Volume 169, Number 18 (Friday, January 27, 2023)]
[House]
[Pages H477-H481]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                GRAVE CONCERNS FOR TRICARE BENEFICIARIES

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 9, 2023, the gentleman from Georgia (Mr. Carter) is recognized 
for 60 minutes as the designee of the majority leader.


                             General Leave

  Mr. CARTER of Georgia. Mr. Speaker, I ask unanimous consent that all 
Members may have 5 legislative days in which to revise and extend their 
remarks and include extraneous material on the subject of this Special 
Order.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Georgia?
  There was no objection.
  Mr. CARTER of Georgia. Mr. Speaker, during my Special Order today, my 
colleagues and I will express grave concerns about the impact that our 
servicemembers and their families are facing as a result of the Defense 
Health Agency's decision to proceed with Express Scripts pharmacy 
network contract.
  We are going to address how TRICARE beneficiaries are no longer 
guaranteed access to their medication at their local pharmacy of 
choice. This decision by Express Scripts has severely impacted those 
who serve or have served our country honorably by reducing patients' 
access to quality healthcare.
  We continue to hear from pharmacists and patients across the country 
who are expressing concerns about these changes.
  Let's keep in mind that Express Scripts is currently under Federal 
investigation by the Federal Trade Commission for their role in 
increasing prescription drug costs and unfair and deceptive practices 
towards pharmacies.
  Servicemembers and their families who rely on their local pharmacist 
for critical care, such as cancer treatments or knowledge of their 
medical history, are now forced to seek that treatment elsewhere.
  It is our responsibility to ensure that their access to affordable, 
quality healthcare is not hindered.
  The Biden administration has tools at their disposal to stop this, 
but instead, they are turning a blind eye.
  Express Scripts, Inc., a pharmacy benefit manager, PBM, for the 
TRICARE program while serving as a mail-order and specialty pharmacy 
itself, made the pocket-lining move of reducing the number of TRICARE's 
in-network pharmacies by almost 15,000 last October.
  Luckily, there are some businesses, like EPIC Pharmacy Network in my 
district, that decided to continue filling these prescriptions despite 
the loss.

  On top of that, Kroger has announced that their pharmacies will no 
longer be able to serve TRICARE beneficiaries. As a result, hundreds of 
thousands of men and women of the United States Armed Forces, military 
retirees, and their families are at risk of losing access to necessary 
prescription drugs and treatment.
  Since that date, beneficiaries in rural communities have been left 
with no local options for filling their prescriptions.
  I used to own and operate a local pharmacy. In fact, I used to own 
and operate three local pharmacies. Understand that no matter how badly 
we want to help people, at the end of the day you are running a 
business, and that business needs to be profitable so that it can keep 
its doors open.
  The sudden and wrongful reduction goes far beyond simply reducing 
access to care for TRICARE beneficiaries.
  For those who need specialty medicines, the mail-order pharmacy used 
by Express Scripts threatens the medical integrity of the medicine and 
places the beneficiaries at risk of receiving the medications late, 
damaged, or missing.
  Of greater concern, it eliminates the crucial role pharmacists play 
in protecting beneficiaries' health, especially those requiring 
multiple medications where contraindications are always a concern.
  Overall, these pharmacy network changes will put servicemembers and 
their families at risk in receiving the prescription drugs and 
treatments they need.
  These brave men and women dedicated their lives to defending our 
freedoms, and one of the things we promised them when they signed up is 
quality healthcare while they served and when they retired from the 
military, as well.
  We are repaying them with a healthcare system that profits off of 
sick military personnel, family members and retirees.
  Luckily, there are some businesses, like EPIC Pharmacy Network in my 
district, that decided to continue filling these prescriptions despite 
the loss. I applaud that decision, but they never should have been put 
in this position to begin with.
  It is a pain for pharmacies, but it is detrimental to our military 
servicemembers and their families.
  These brave men and women dedicated their lives to defending our 
freedoms. We are repaying them with a healthcare system that puts 
profits ahead of people.
  I brought this to the attention of the Defense Health Agency back in 
October to discuss how we could restore local pharmacy access to these 
patients.
  As a pharmacist myself, whose Congressional District is home to every 
single branch of the military and a large veteran community, I was 
dumbfounded by their response: No one cares about losing access to 
their local pharmacy? You have got to be kidding me.
  It is one thing to make that claim to me; it is another to make it to 
the nearly 800 men and women who sent me their personal story detailing 
how losing access to their medicine is impacting their health and their 
well-being.
  Hunter, a servicemember from South Carolina, saw the cost of his 
prescription go up by almost 600 percent after Express Scripts made 
changes to the TRICARE pharmacy program.
  Is this how we want to treat our heroes who have given everything for 
our country, by increasing the cost of their medication by 600 percent? 
Seriously?
  Or Jacqueline, who says this move ``has made the difference between 
stopping to get medicine on the way home or going an additional hour or 
more to the nearest base pharmacy before going home.''
  For patients like James, a retired Air Force veteran, this move was 
more than just a frustration. It was a direct attempt to undermine 
small business. ``Why would the Federal Government choose large chains 
over supporting small businesses,'' he asks?
  ``In my neighborhood store, I am not just a number. The service I 
receive is far better than the big box pharmacies--once again, the 
large companies are trying to squeeze out the little ones. When will 
the Federal Government stop supporting this?''

[[Page H478]]

  It is time for the Biden administration to answer James' question or 
at a minimum the questions posed by a bipartisan coalition of 
legislators in the two letters I have led to the DHA on this issue.
  I am mailing these stories to the White House because servicemembers 
and their families shouldn't be cut out of their own healthcare 
decisions.
  I look forward to hearing from my Republican and Democrat colleagues 
about these issues.
  Mr. Speaker, I yield to the gentlewoman from Tennessee (Mrs. 
Harshbarger), a fellow pharmacist and a Member of Congress who 
represents the First Congressional District of Tennessee, so she can 
share her thoughts on this subject, as well.
  Mrs. HARSHBARGER. Mr. Speaker, I thank my friend, Buddy Carter from 
Georgia, for yielding.
  Mr. Speaker, I rise today because our veterans deserve better.
  Our Active-Duty servicemembers and veterans chose to serve this great 
Nation knowing it would take unimaginable sacrifice and precious time 
away from their loved ones.
  Many of them left their lives behind and were taken to far corners of 
the world to face enemies of democracy. They did this for us, for our 
freedom, for our ability to stand here today without fear of 
persecution.
  This is a sacrifice we should all feel indebted to, including those 
people at Express Scripts. For those of you who are unfamiliar with the 
company, it is a Cigna-owned pharmacy benefit manager, known as a PBM, 
that administers the TRICARE benefits on behalf of the Department of 
Defense.
  Last year, the Department of Defense allowed this PBM--and this was 
suddenly and without warning--to institute pharmacy network changes 
that impacted 400,000 TRICARE beneficiaries by removing almost 15,000 
independent community pharmacies from the retail network.

                              {time}  1400

  Most people in this country live 5 minutes from a pharmacy. They have 
immediate access to a pharmacist. They don't have to make an 
appointment, and they can go in and talk to that professional.
  Most of those pharmacies are now excluded. They are located in rural 
and underserved areas. These people are no longer able to rely upon 
their local pharmacy to access needed medications and in-person 
pharmacist counseling.
  These TRICARE beneficiaries and their families are being forced to 
drive sometimes long distances to find a corporate, in-network 
pharmacy, or if they can't do that, they are funneled into an Express 
Scripts mail order program, and that is unacceptable.
  This abrupt change by PBM giant Express Scripts is especially 
problematic for a small group of TRICARE beneficiaries who are 
chronically ill, that have a disability and receive infusion 
medications in their homes.
  It will almost certainly delay care for those patients with chronic 
conditions such as rheumatoid arthritis, heart disease, cancer, and 
diabetes.
  By the way, I am talking to oncology groups now that are absolutely 
tracking that these patients do not get their medicine in time, or go 
without their cancer drugs, and it causes an immediate response and a 
degradation of their health based on the cancer that they have.
  The department's decision to carry on with this contract despite the 
grave impacts we all knew would impact our veterans and servicemembers 
is reprehensible.
  Veterans and Active-Duty servicemembers and their families are losing 
access to quality care, and those with cancer and rare diseases are 
often being faced with the impossible choice of switching to a new 
pharmacy that may be far, far away or paying out of pocket to stay with 
the pharmacy they have come to know and trust.
  America made a promise to our veterans. We promised to take care of 
those who have risked their lives to defend us. Leaving our heroes in 
jeopardy to line the pockets of a multibillion dollar PBM is 
inexcusable.
  As a licensed pharmacist for over 30 years, I know how much a 
community leans on their trusted, independent pharmacist, and 
especially in rural areas like I serve and like Buddy serves.
  It is true that pharmacists are still one of the most accessible 
healthcare providers in the United States. Trusting the pharmacist 
dispensing one's medicines has a very real impact on health outcomes 
and costs for the patients.
  I thank Congressman Buddy Carter for his leadership on this important 
issue. Buddy and I were both pharmacists in our former careers, we 
still are pharmacists, and we know firsthand just how much this policy 
will hurt health outcomes.
  Our veterans and Active-Duty servicemembers deserve to trust that 
they can access the medication that they rely on, and they deserve to 
have strong advocates against these greedy PBMs.
  They deserve all our thanks and more. They deserve so much better. 
The Department of Defense must reverse this grave injustice, and I 
won't stop fighting until our heroes get what they have earned and what 
they are owed.
  Mr. CARTER of Georgia. I thank Representative Harshbarger for her 
insightful comments. We are very fortunate to have her in Congress and 
very fortunate to have her representing the profession of pharmacist.
  As she indicated, she understands firsthand the impact that this is 
having on patients. After all, she was on the other side of the counter 
for many years, just like I was.
  At this time, Mr. Speaker, I yield to the gentleman from the great 
State of Colorado (Mr. Lamborn).
  Mr. LAMBORN. Mr. Speaker, I am pleased to come to the floor of the 
House of Representatives to discuss the need for TRICARE beneficiaries 
to have access to quality healthcare.
  I thank Mr. Buddy Carter, my friend from Georgia, for his leadership 
on this important issue.
  The military population in my home district of Colorado Springs is 
well over 100,000 people. It includes Active-Duty, National Guard, 
Reserves, retirees, and veterans, including their families and 
dependents, the number of TRICARE beneficiaries in my district is 
substantial.
  The impact of Express Scripts cutting the number of in-network 
pharmacies and reducing reimbursements has been felt in Colorado 
Springs.
  I have heard from constituents who have had trouble finding quality 
pharmacies for their prescriptions and who are faced with increasingly 
long wait times, decreased hours of service, and unscheduled closures.
  Additionally, beneficiaries in my district have had to change their 
pharmacy numerous times as TRICARE rates continually fluctuate.
  The process of finding a new pharmacy takes up a substantial amount 
of time and beneficiaries ultimately cannot reliably depend on a 
pharmacy to consistently deliver their necessary medicine.
  The men and women serving in our military, retirees and their 
families who serve alongside them, deserve more options for their 
healthcare, not less.
  Access to quality, accessible, reliable pharmacies should not be 
something that our military families have to worry about.
  I urge the Defense Health Agency and Express Scripts to carefully 
consider the impact these recent changes have made on military families 
and to make the changes necessary to facilitate increased pharmacy 
access and availability to beneficiaries of the TRICARE network.
  Mr. CARTER of Georgia. I thank the gentleman from Colorado.
  If you will notice, one of the things that he pointed out and I 
pointed out earlier in my remarks, he represents a lot of veterans. He 
represents a lot of people who have retired in his district.
  These military bases, many of our veterans, when they leave the 
service, they retire in the area where they have been serving.
  That is certainly the case in my district, and I suspect it is the 
case in Representative Lamborn's district as well.

  That is why this is having such a big impact on people. It has 
disrupted their lives. This is not just a cost-saving move here.
  This move has impacted veterans who served our country, sacrificed 
for our country. It has impacted them and

[[Page H479]]

their families after we promised them we would give them quality 
healthcare, affordable healthcare, and yet, it has done just the 
opposite.
  Thank you, Representative Lamborn, for your comments.
  Mr. Speaker, at this time, I recognize a good friend of mine and a 
fellow member of my delegation who also represents an area with a heavy 
military presence and a heavy veteran presence in his district just 
north of my district.
  I know that Fort Gordon is in his district, and I know that there are 
a lot of retirees and a lot of veterans who have retired in his 
district as well.
  I yield to the gentleman from Georgia (Mr. Allen).
  Mr. ALLEN. Thanks to my friend and colleague from Georgia, Mr. 
Carter, for organizing this Special Order and for your leadership on 
this issue.
  This is an important issue. You know, growing up and then, of course, 
now, you know, my pharmacist is a dear friend of mine.
  I don't want to go to another pharmacist, although you get all these 
offers to get this through the mail and all that. To me, your 
pharmacist is kind of like choosing your doctor.
  I mean, they do so much for the communities that they serve, 
particularly in rural America.
  But what we are talking about here, and as Congressman Carter said, 
it is about the American troops, our veterans and their families that 
are at risk of losing access to lifesaving prescriptions.
  In October, the Defense Health Agency's pharmacy benefit manager, 
Express Scripts, cut nearly 15,000 pharmacies from its network, all 
because they wouldn't accept Express Scripts' outrageous terms.
  Why does this happen?
  I mean, of course, obviously we are shining a light on this because 
the entire country needs to know about this, particularly our veteran 
communities.
  This decision left a quarter of a million people with few or no 
local, in-person options to access the medicine and treatments they 
need.
  Countless Americans choose to get their prescriptions filled at their 
local or independent pharmacy specifically because of the quality of 
service they provide.
  Like I said, it is a personal thing. It is a relationship. Your 
pharmacist has knowledge of your medical history, and the relationship 
that patients have with their community pharmacist is important, and it 
must be allowed to continue.
  This choice is important, especially for veterans who have sacrificed 
so much. This decision has negatively impacted scores of veterans, 
particularly those living in rural areas like the ones I represent in 
Georgia 12.
  My colleagues and I will continue to put pressure on this 
administration to do the right thing and step up to ensure that 
community and retail pharmacies are able to continue to serve our 
military by offering reliable, local access to their medicine. This is 
critical.
  Mr. CARTER of Georgia. I thank the gentleman for his comments.
  I want to point out one thing that he so astutely pointed out, and 
that is about the rural areas. Keep in mind, now, yeah, they are still 
going to have a lot of the big box pharmacies that are going to be 
participating in this. They will still have the mail order, but there 
are a lot of rural areas that are going to be impacted here. A lot of 
our veterans live in rural areas.
  Mr. Allen's district, like my district, has a lot of rural area in 
it. Our constituents are impacted by this.
  Thank you for your comments.
  Mr. Speaker, I want to point out one other thing. Express Scripts is 
one of three PBMs in this country that control 80 percent of the 
market.
  That's right. Express Scripts is one of three PBMs in this country 
that control 80 percent of the market.
  Now, of TRICARE, they have this contract. They control 100 percent of 
the people covered under this contract. But it is also important--we 
mentioned mail order, and mail order is a big component of this as 
well.
  By the way, Mr. Speaker, Express Scripts PBM, guess who owns the mail 
order pharmacy that they are using? They do.
  That's right. Express Scripts PBM, which is owned by Cigna Insurance, 
also owns the PBM and the mail order pharmacy.
  So they are pushing these patients to their pharmacy. They are 
pushing them away from the independent retail pharmacy and pushing them 
to their mail order pharmacy.
  And you wonder how they are going to save money?
  Mr. Speaker, at this time, I recognize a new Member of Congress and a 
new member of the Doctors Caucus. We are delighted to have the 
Congresswoman from Virginia, Representative Jen Kiggans, as a member of 
our Doctors Caucus, and as a Member of our body. I invite her now to 
make comments on this as well.
  Mrs. KIGGANS of Virginia. I thank the gentleman from Georgia, Mr. 
Carter, for yielding me time to speak on this important issue.
  Mr. Speaker, it is fitting that my first address on the House floor 
is about a subject that is important to me and so many people in my 
district.
  As a Navy veteran and a primary care nurse practitioner, I am well 
aware of the challenges that our servicemembers face in the healthcare 
arena.
  Over the past few weeks, I have heard from countless concerned 
constituents who are unable to get their medications from their local 
pharmacy because the pharmacy is no longer in the TRICARE network.
  It is not just TRICARE members who are being affected by this change. 
I recently talked to a constituent who owns a small pharmacy on 
Virginia's Eastern Shore.

  They are at risk of losing a significant percentage of their business 
because the reimbursement rates issued from TRICARE are now too low to 
be sustainable for pharmacy owners.
  I was sent to Congress to help the people of Virginia's Second 
District in any and every way that I can.
  This new contract helps absolutely no one. In fact, it does just the 
opposite.
  Our military and military families need to remain strong to be 
effective. It is our job to ensure their needs are met and their health 
is prioritized. Make no mistake; this TRICARE contract does neither.
  I strongly urge TRICARE to return to the negotiating table and ensure 
military members and their families can receive their medications, and 
our pharmacies are fairly compensated.
  Mr. CARTER of Georgia. I thank the lady from Virginia for her very 
insightful comments. She, herself, a veteran. She, herself, a 
healthcare professional. She, herself, who has seen the impact that 
this has had on veterans and on their families.
  The inconvenience, how they are having to travel further now to get 
their prescriptions, how they are having to pay more.
  All of this after they served our country, sacrificed for our 
country, and now this is the way that we are going to repay them, by 
allowing a company that has as their motive profit to treat them this 
way?
  Is that the way the Biden administration wants to handle this?
  Is that what they want to allow?
  I don't think so.
  Mr. Speaker, at this time, I yield to the gentleman from Alabama (Mr. 
Moore). Another valuable Member of the United States Congress and a 
neighbor to my west. I ask him for his comments.

                              {time}  1415

  Mr. MOORE of Alabama. Mr. Speaker, I am fortunate to be able to 
represent a district full of patriotic veterans who have served this 
country honorably. Every American and, certainly, Congress, owes our 
veterans, all we have promised them, and more.
  The issue we are discussing today has imposed significant hardships 
on veterans and their families who have long relied on trusted, local, 
and convenient healthcare professionals for their prescription 
medications.
  Due to negotiations between Express Scripts on behalf of the 
Department of Defense and independently owned pharmacies, thousands of 
local pharmacies are unable to provide prescriptions for TRICARE 
patients.
  This means that many retail pharmacies are unable to work with 
TRICARE customers, restricting pharmacy access for millions of people 
all over the country, including many in my district and primarily in 
rural Alabama.

[[Page H480]]

  I have heard numerous upsetting stories from my constituents who have 
been impacted. One tells me he can no longer use Express Scripts due to 
his medication prices more than doubling from his local pharmacy, which 
no longer accepts TRICARE. He recently waited over 4 hours for his 
prescriptions at his new pharmacy.
  Another constituent, who recently had to stand in line at a pharmacy 
for over an hour with other upset patrons, explained to my office that 
multiple times Express Scripts has run low on his mental health 
medications and failed to deliver them to him on time, causing a 
dangerous interruption in his medication schedule.
  Mr. Speaker, one of my constituents has used the same pharmacy for 54 
years and thinks of them as a partner. They are in frequent 
communication regarding her health, and the professionals there often 
help her decide which medications will be most beneficial to her.
  Unfortunately, Express Scripts has not met her needs. When visiting 
another pharmacy recommended to her by Express Scripts, she was 
informed that they are not a fully functional pharmacy and that they 
were also unable to help her.
  She has told my office that our veteran population loves our country, 
but too often it seems our country does not love them back.
  The treatment of our own veterans is unacceptable and, in the 
greatest country in the world, our government must do everything 
possible to alleviate the suffering of our veterans and their families, 
who have already sacrificed so much.
  I appreciate my colleague, Buddy Carter, an experienced independent 
pharmacist, for hosting this Special Order and his leadership on this 
issue.
  We have no greater responsibility than keeping our promises to our 
veterans, and I am committed to ensuring that families using TRICARE 
receive the utmost care from their trusted, local healthcare 
professionals.
  Mr. CARTER of Georgia. Mr. Speaker, I thank the gentleman for his 
comments; they are insightful. He, like all of us, has constituents who 
have been inconvenienced and have been rudely and, quite honestly, just 
selfishly disrupted.
  He mentioned the fact that people who have been using the same 
pharmacy for years, now having to find another pharmacy, all because of 
profits, all because this company, Express Scripts, is trying to make 
more money off the back of our veterans. We should be ashamed. This 
administration should be ashamed for letting this happen.
  You hear it from me. You have heard it from some of my colleagues. I 
want to share with you just a couple of stories real quick; a story 
that was sent to me. I mentioned that we have heard from constituents, 
and we have.
  A concerned citizen wrote and said, I have been using the same 
pharmacy since 1985, and now I have to change; no choice of my own, but 
now I have to change. My pharmacist knows my family's medical issues, 
and now I have to train a pharmacist pertaining to my medical history.
  This is an example. Another one--and we are fixing to hear from a 
retired marine and general; but another one.
  As a retired marine Master Sergeant who suffers from exposure to 
Agent Orange and Camp Lejeune water contaminates, my family has used a 
local pharmacy in our hometown of Broken Arrow, Oklahoma, for 25 years. 
Our pharmacist is not only a healthcare provider but is also a well-
known friend and neighbor.
  One of B.A. Family Drugs most prized services was free home delivery 
by their Drug Bug, a Volkswagen Beetle. We can no longer rely on that 
excellent service.
  Again, this has disrupted people's lives. But it is more than just 
people; it is our heroes, our veterans.
  At this time I want to recognize, as I mentioned earlier, one of our 
true American heroes, and one that I am honored to serve with in 
Congress, one of our--I believe it is four generals that we have here 
in Congress serving with us now, and that is Congressman Jack Berman 
from Minnesota.
  Mr. Speaker, I yield to the gentleman from Minnesota (Mr. Bergman).
  Mr. BERGMAN. Mr. Speaker, I thank the gentleman for taking leadership 
on this; and I have to just correct one thing for the Record. I was 
born in Minnesota, but now I represent Michigan; and that is okay. I 
have roots in both because I was raised by a Minnesota farm girl, and 
now I am married to an Iowa farm girl. So now if we can get Iowa in 
there at some point, we will be in good shape. I will be happy at home.
  When I just referenced my mom and my wife, my dad was in World War 
II. My father-in-law was in World War II. When we think about the 
sacrifices everyone in our country made, it was really the families 
that sacrificed on the front end to ensure that their loved ones, 
servicemembers deployed around the world to end the tyranny of World 
War II, that the family members at home sacrificed to ensure their 
servicemembers could fight the fight.
  I think, today, it is true, and still is true, that when you talk 
about TRICARE and all the services that it provides, it is not about 
the servicemember, it is about the servicemember and their family 
because without the comfort of knowing that the family is being taken 
care of by the TRICARE system; that it is a system that does not 
institute change for the wrong reasons.

  What we are hearing today, this is change for profit's sake, and that 
is the wrong reason.
  So when you think about, what is readiness? Our troops have to be 
trained and ready to deploy at a moment's notice to protect our 
national security. That readiness includes family readiness.
  Family readiness includes the availability of TRICARE, the 
availability of prescriptions, especially in my district, in the Upper 
Peninsula of Michigan, and northern and lower Michigan, where we have a 
lot of rural and remote families that can't get to the pharmacy every 
day; that cannot--whether it is snowstorm, whether it is age, whatever 
it is, we need to ensure that our TRICARE system is robust, it is 
complete, it is fair pricing to make sure that, in the end, everybody 
wins, not just a couple.
  We have got roughly--the Department of Defense requirements--TRICARE 
supports about 9.4 million servicemembers, retirees, and their families 
around the world. That doesn't seem like much in a Nation of 330 
billion. But guess what? It means everything to that 9.4 million 
servicemembers and their families.
  The comprehensive nature of TRICARE, as we saw during the COVID time, 
advancement of telehealth, the advancement of diagnosis, the 
advancement of treatments, prescriptions, and all of that, it all 
blends the work going forward and what we need to do to support our 
servicemembers and their families.
  It is incumbent upon us, as Members of the House of Representatives, 
and the Senate, and the President, to ensure that no policy is put into 
place that gives any entity an unfair advantage when it comes to their 
priorities versus the needs and the priorities that we have and our 
commitment to our members of the Armed Forces.
  So with that, we know this is ongoing; and I can tell you one thing, 
as a member of the VA Health Subcommittee, and on the Committee on 
Armed Services, I look at this issue from the front end of recruiting 
and enlistment standards, to retention, to retirement, to going into 
the VA system, all the way along in that servicemember's life and their 
family's life, and we are committed here to doing the right thing for 
those folks because they did the right thing for our country.
  Mr. CARTER of Georgia. Mr. Speaker, I thank the gentleman for his 
service to our country and for his interest in this subject. It is 
extremely important, and we appreciate his leadership.
  Mr. Speaker, again, I want to share with you some of the comments 
that we have gotten in our office. From Rick P: My neighborhood 
pharmacy is 5 minutes away and is the only one in town. But now, with 
changes, I have to go 30 minutes to and from the nearest pharmacy in 
the next town. That is not right. I have been going to the same 
pharmacy for 22 years, and they know my medical problems and 
prescriptions I take.
  This is the way we are going to treat our veterans. This is the way 
we are going to treat our veterans' families.
  From Bob S. In Gainesville: I am retired Air Force. My wife and I 
live in

[[Page H481]]

Gainesville, Georgia. We currently use Express Scripts mail order 
pharmacy, or VA mail order when possible. My wife has insurance through 
her employer which makes her ineligible for Express Scripts mail order. 
It also means she can only use three pharmacies that accept both 
insurance. We find-- Listen to this, Mr. Speaker. We find ourselves 
driving 3 hours one way so we do not have to pay $2,000 out of pocket 
each month for her medications. Now, with fewer pharmacies accepting 
TRICARE, we will probably have to make the trip more often.
  Wow, what a promise we are keeping to these veterans. We are 
promising them that we are going to give them quality healthcare for 
their sacrifice, for their service to our country; and we are making 
them drive 3 hours, one way, so that they can save on the co-payment 
and won't have to pay $2,000 out of pocket. Ridiculous.
  Another concerned citizen. I called to have a prescription refilled 2 
weeks before I was out of my medication. However, my medication never 
came. I called Express Scripts to inquire about its status, and they 
told me that I had no refills. So I currently am out of medication, and 
per Express Scripts, I cannot get my medication for 2 to 3 weeks. How 
is this right? I have served my country for 30 years, and I cannot get 
my medication for 2 to 3 weeks?
  What are we supposed to tell these people?
  What are we supposed to tell our veterans?
  Mr. Speaker, this is not acceptable. You don't want this. I don't 
want this. No Member of Congress wants to see this.
  So why is it that the Department of Defense is not addressing this? 
Why aren't they responding to my letters? Why aren't they accepting my 
invitations to come to their office and talk to them about this?
  Another concerned citizen. We live across the street from a locally 
run independent pharmacy. We strongly believe in supporting local 
businesses and having the choice of where we get our medical needs. 
Isn't that what America is supposed to be about? Please do whatever 
possible to keep our local pharmacy in the network. Local businesses, 
small businesses, are important to our communities.
  Another concerned citizen: We live in a small town with only one 
pharmacy, which Express Scripts has quit doing business with. Our only 
other alternatives are pharmacies that are either 20 miles away or 10 
miles away. With the price of gas, this just adds another expense to 
the already high cost of medication.
  Bob P. writes: They removed our local pharmacy that was walking 
distance from our home. We now need to travel several miles for the 
next pharmacy on the very limited list. This was a surprise when they 
deleted so many pharmacies off the list.

  On and on and on; all of these messages sent to our office. Why were 
they sent to our office? Because, obviously, they know I am a 
pharmacist. Obviously, they know I am working on this issue.
  Mr. Speaker, this is despicable. No one should--no American should 
have to suffer through this, but especially our veterans who sacrificed 
for our country.
  You see the comments back here. We depend on the Coast Guard to do 
search and rescue. They should be able to obtain their medications from 
their local pharmacy and pharmacist.
  It is like the years of service I gave to this country are no longer 
appreciated. It is like us veterans are unimportant to this Nation.
  Is that the message we want to send? No.
  They will no longer have access to our free deliver service or access 
to a live pharmacist in a timely manner. It is sad, it is dishonest, 
and greedy on the part of Express Scripts for agreeing to this.
  One last letter that we received. Our local independent pharmacy has 
expertly provided for us and have become like family. Our local 
neighborhood businesses are very important to community strength and 
solidarity and cutting them out further weakens the ties that help to 
keep communities strong and viable. Please strengthen families and 
communities by reinstating local and independent pharmacies.
  That is why, currently, as we speak, the FTC, the Federal Trade 
Commission, is looking into the impact that the PBMs are having on 
local independent pharmacies; something that I asked them to do 8 years 
ago when I first entered Congress.
  The first thing I did when I got to Washington, D.C., was to call the 
FTC and ask them to look at the vertical integration that exists in the 
drug pricing scenario, where the insurance company owns the PBM that 
owns the pharmacy.

                              {time}  1430

  That is right. Aetna owns Caremark, which owns CVS. Cigna owns 
Express Scripts PBM, which owns Express Scripts mail order. Then you 
have United--same thing.
  Thank goodness, last summer, the FTC agreed to look at this vertical 
integration that has caused the prices of prescription drugs to go so 
high. There was a study done by the Berkeley Research Group last year. 
It showed, Mr. Speaker, that only 37 percent of the price of a 
medication goes to the pharmacy manufacturer, which begs the question: 
Where does the other 63 percent go?
  Guess where it goes? It goes to the PBM, the middleman, to Express 
Scripts, those types of companies. That is where it goes.
  Now, look, I am not opposed to anybody making money, but at the same 
time, tell me the value they are bringing to healthcare. They are not 
bringing any value to healthcare.
  The egregious policies of the PBMs are what are causing prescription 
drug prices to go up, and now they are cutting out the local 
independent pharmacies, and now they are penalizing our veterans, 
causing them to have to drive miles and miles and do without their 
medication and pay higher prices all to make more profit.
  Mr. Speaker, this is why we are here today. It is because of the 
patients. It is because of our veterans and their families. They are 
the ones that are suffering. They are the ones that need the Biden 
administration, who can do something about this and who should do 
something about this. They are the ones who need them to step up.
  These stories should not be our brave servicemembers' reality. We can 
and must do better.
  Mr. Speaker, I yield back the balance of my time.

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