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) 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 a delay to allow sufficient time to prepare for the changeover, Express Scripts took over providing pharmacy benefit Services to the over 117,000 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 manager 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 are awaiting a response to our letter from CDC and will update this post with any additional information we receive.

Having problems with Express Scripts?

If you are a 911 responder or survivor and you experience any disruptions with receiving your prescriptions you can contact 911 Health Watch by going to our web respond portal and we will get back to you.

Here is our 911 Health Watch Contact Us Portal.

WTC Health Program Website on Pharmacy Benefit Manger Transition

Documents

Public Information on CDC Pharmacy Benefit Manager Contract

Pharmacy Benefit Manager Contract Award

Letters

August 12, 2022 911 Health Watch letter to CDC Director Dr. Rochelle Walensky

Last updated: September 1, 2022