At Hearing with Express Scripts CEO, Warren Raises Concerns About Anti-Competitive Tactics, Self-Dealing In Military Pharmacy Program

Warren calls on Pentagon to ban vertical integration in next TRICARE pharmacy contract Video of Remarks (Aging Committee Website) Washington, D.C. — At a hearing of the Senate Armed Services Subcommittee on Personnel, Ranking Member Elizabeth Warren (D-Mass.) delivered opening remarks highlighting how Express Scripts, the largest pharmacy benefit manager in the United States and exclusive administrator of the military’s TRICARE pharmacy program, may be pushing local pharmacies out of the TRICARE network and driving more business to itself, while limiting access to timely, personalized care for service members and their families. The Express Scripts CEO attended the hearing as a witness. “The consequences of losing access to your local pharmacy can be immeasurable. Think about veterans with complex medical needs, who rely on the personalized care from their local pharmacist… It is the kind of care that we want for our military families – and what they deserve,” said Senator Warren . Express Scripts has held the exclusive contract to manage the TRICARE pharmacy program for 23 years, while owning and operating two mail order pharmacies, Express Scripts Pharmacy and Accredo Specialty Pharmacy, that also participate in the TRICARE network. As the government’s contractor, Express Scripts has the power to decide which pharmacies are in network and how much they are reimbursed. As a result, in the last four years alone, over 13,000 local pharmacies have left the network, leaving 400,000 military families scrambling to find a new covered pharmacy. “That is a clear conflict of interest…(I)t is an open invitation for Express Scripts to milk the federal government, kick out competitors, and steer big bucks to itself,” said Senator Warren , while also noting that the Defense Department actually requires the TRICARE pharmacy contractor to own both a pharmacy benefit manager (PBM) and a pharmacy. Express Scripts denies that it uses tactics like “spread pricing,” charging insurers more than what they reimburse pharmacies for a drug, or that it engages in self-dealing. Senator Warren called out Express Scripts and the Department of Defense for refusing to provide Congress with documentation to support these claims, which Express Scripts and the Department have claimed are “proprietary” or “trade secret.” “If DOD and Express Scripts refuse to share this data, we can draw only one conclusion: the contract that DOD and Express Scripts want us to believe is so different is not so different after all,” Senator Warren said . “If DOD wants to use a PBM, get one that works exclusively for DOD and American taxpayers – and not one that works simultaneously to increase profits for its parent insurance company,” concluded Senator Warren . In a May hearing , Senator Warren pressed Assistant Secretary Bass to commit to conducting annual audits of TRICARE’s pharmacy contract and providing Congress with the difference in reimbursement rates, fees, and other price concessions for Express Scripts-owned pharmacies and their competitors in the network. Bass agreed, but two months later has not supplied this information. Senator Warren recently secured an amendment in the FY 2027 National Defense Authorization Act (NDAA) to require an audit of the Express Scripts contract. In her remarks, Senator Warren also calls on the Defense Department to ban vertical integration in the next TRICARE pharmacy contract, which is currently under development. During her opening remarks, Senator Warren also entered  into the Congressional record testimony from over 50 pharmacists describing their experience with TRICARE and Express Scripts. Transcript: Senator Warren’s Opening Remarks at a Hearing to Receive Testimony on the TRICARE Pharmacy Program Senate Armed Services Subcommittee on Personnel July 15, 2026 As Prepared for Delivery Senator Elizabeth Warren: Thank you, Mr. Chairman, and thank you to our witnesses for being here. We are here today because the TRICARE pharmacy program lacks meaningful oversight. Since 2022, 13,000 pharmacies have left the TRICARE network. That means 13,000 local pharmacies can no longer fill prescriptions for our servicemembers and 400,000 military families must find new pharmacies. The consequences of losing access to your local pharmacy can be immeasurable. Think about veterans with complex medical needs, who rely on the personalized care from their local pharmacist – someone who will check for drug interactions, package medications to maximize adherence, and comfort a caregiver overwhelmed by their responsibilities. It is the kind of care that we want for our military families – and what they deserve. I have letters from 58 pharmacists who speak to this directly. I request that they be entered into the record. This subcommittee has a responsibility to understand why this type of care is shrinking in TRICARE. So we need to look at the contractor running this program. Since 2003, DOD has awarded the TRICARE pharmacy contract to Express Scripts – the largest pharmacy benefit manager or PBM in the country. For 23 years, they have had an exclusive contract—with the most recent contract worth at least $4.3 billion in revenues over seven years. So what does Express Scripts do with billions in taxpayer dollars? They decide which retail pharmacies are in the TRICARE network and what they get paid. They process pharmacy claims. And they run a mail order program through Express Scripts’ subsidiaries: Express Scripts Pharmacy and Accredo Specialty Pharmacy. There’s the kicker: Express Scripts both decides reimbursement rates for its competitors and provides its own pharmacy services—and all of it gets billed to TRICARE. That is a clear conflict of interest. And yet, DOD actually requires the TRICARE pharmacy contractor to own both a PBM and a pharmacy. I don’t know who talked them into that, but it is an open invitation for Express Scripts to milk the federal government, kick out competitors, and steer big bucks to itself. This squeeze play isn’t hard to pull off. In a “traditional” PBM contract, when the same company owns a PBM and a pharmacy, it can leverage this vertical integration through tactics like: Spread pricing, in which PBMs charge insurers more than what they reimburse pharmacies for a drug; and Steering, in which they under-reimburse competitors and send more business to the pharmacies the PBM owns. DOD and Express Scripts are quick to clarify that the TRICARE pharmacy contract is not a “traditional” PBM contract, so they claim these profit-maximizing games don’t apply. The problem is the facts. Audits of Express Scripts’ other government contracts show exactly these practices, but DOD and Express Scripts want you to believe that there is nothing to see here. OK, but if that were true, DOD and Express Scripts should be rushing to provide this Committee with proof. Yet, for three years, I have repeatedly asked for the terms of DOD’s contract with Express Scripts only to be told that what DOD pays for prescription drugs is either “proprietary” or “trade secret” and people like the Chairman and me, whose job it is to conduct oversight over exactly this issue, can’t see it. After I pressed Assistant Secretary Keith Bass on the Department’s weak oversight of this contract during a hearing before this subcommittee in May, he committed to conduct an annual review of the contract and to disclose the differences in reimbursement rates and fees between retail pharmacies and Express Scripts’ subsidiaries. But nearly two months later, I am still waiting. If DOD and Express Scripts refuse to share this data, we can draw only one conclusion: the contract that DOD and Express Scripts want us to believe is so different is not so different after all. I’m glad this committee included a requirement in the Fiscal Year 2027 NDAA to audit this contract. We need to pass it into law. DOD has also begun negotiating the next pharmacy contract, which will take effect in 2030. I urge DOD to flatly prohibit vertical integration in the next TRICARE pharmacy contract. A vertically integrated PBM has every incentive to line its own pockets, and DOD should not be using taxpayer dollars to fund these schemes. If DOD wants to use a PBM, get one that works exclusively for DOD and American taxpayers – and not one that works simultaneously to increase profits for its parent insurance company. I look forward to discussing these topics with our witnesses. ###