Pharmacy Benefit Manager (PBM) Contract
On April 15th, 2021, the CDC announced the solicitation of bids from potential contractors to deliver Pharmacy Benefit Manger Services to the World Trade Center Health Program.
On September 14, 2021, the Centers for Disease Control (CDC) awarded the contract to provide Pharmacy Benefit Manager Services for the World Trade Center Health Program (WTCHP) to Express Scripts, (Contract Number 75D301-21-C-12499) which is owned by Cigna Insurance which was ranked 12 largest company in the US in 2021, replacing the previous Pharmacy Benefit Manger Optum RX which had been providing Pharmacy services to the program for the past 5 years.
On June 1, 2022, after an extensive delay to prepare for the changeover, Express Scripts took over providing pharmacy benefit Services to the over 118,000 Members of the World Trade Center Health Program.
Since the June 1, 2022, go live date, 911 Health Watch has been very concerned with the performance or rather the lack of performance by Express Scripts raising concerns about the CDC contracting office’s ability to manage the contract and enforce contractor requirements to perform services.
As we detailed in our August 12, 2022, letter to the CDC Director Dr. Rochelle Walensky,
We hope you are aware of the extent of the problems that the WTCHP Members are having with Express Scripts. We know that the staff of the program are working to try to fix the problems, but given the sub-par performance of the company as compared to the prior provider, Optum, additional urgent action is needed by CDC to force Express Scripts to address the gross deficiencies in their delivery of services under the contract, and to hold the company accountable for its failure to provide reliable, timely fulfillment of pharmacy benefits to program members.
There are too many members, especially in the WTCHP National Program, who are not able to access their medications and for whom Express Scripts, even after 10 weeks as the PBM, is showing no real effort to resolve member problems in accessing their medications. Moreover, it appears that Express Scripts is not being held accountable.
We asked, “We want to know: what actions the CDC is planning to take to hold Express Scripts accountable and to make them deliver on their contract obligations?” and outlined ten areas of concern.
We have been informed that inadequate contract performance has been brought to the “highest level” at Express Scripts, the President of the company, and that “new additional resources” are being applied to resolve the problems.
We understand that program transitions to new contractors are difficult, but despite the best efforts at preparation by the Program, it is evident that Express Scripts was and remains woefully unprepared to perform the contract that they bid on and were awarded.
We finally received a response to our letter from the CDC on October 13th, 2022.
Seeking assistance with the complex issues regarding federal contracting and oversight of those contracts, 911 Health Watch sought the assistance of the Project On Government Oversight (POGO) and gave it a $10,000 grant to help in the review of the CDC’s contracts. Founded in 1981, POGO is a nationally recognized nonpartisan independent watchdog that investigates and exposes waste, corruption, abuse of power and when the government fails to serve the public or silences those who report wrongdoing.
On September 19th, 2022, consulting with 911 Health Watch, POGO sent a letter to Director of the CDC, Dr. Rochelle Walensky regarding the CDC’s contract office and its management of contracts to assist the World Trade Center Health Program.
The POGO letter asks specific questions and raises concerns over the CDC’s award and administration of the WTCHP’s three recently initiated contracts: the Nationwide Provider Network contract, the Pharmacy Benefits Manager contract, and the Third-Party Administrator contract.
On October 13th, 2022, POGO received a response from the CDC.
911 Health Watch does not believe that the CDC has addressed our concerns so 911 Health Watch will continue to monitor the contract performance of Express Scripts and highlight the issues WTC Health Program members are experiencing.
HAVING PROBLEMS WITH EXPRESS SCRIPTS?
If you are a 911 responder or survivor and you experience any disruptions with receiving your prescriptions from the WTC Health Program Pharmacy Benefit Manager Express Scripts, you can contact 911 Health Watch by going to our web respond portal and we will get back to you.
WTC Health Program Website on Pharmacy Benefit Manger Transition
August 12, 2022, 911 Health Watch letter to CDC Director Dr. Rochelle Walensky
September 19th 2022, Project on Government Oversight Letter to CDC Director Rochelle Walensky
October 13, 2022, CDC Letter responding to 911 Health Watch.
October 13th, 2022, CDC response to Project On Government Oversight Letter.
9/11 health program users plagued with problems using new medical providers
NY Daily News | November 7, 2022
A change in the companies managing health care for more than 118,000 people sickened by the 9/11 attacks has proven a nightmare for many enrolled in the program.