Medicare Addresses Egregious Pharmacy Audits, Preferred Network Plans, and Mail Order Waste in Part D Prescription Drug Plans

Published Online: Wednesday, April 3, 2013
Follow Pharmacy_Times:
PRESS RELEASE

ALEXANDRIA, Va. (Apr. 3, 2013) – The U.S. Centers for Medicare and Medicaid Services (CMS) has released its final “call letter” setting forth recommendations and requirements for Part D prescription drug plans (PDPs) in 2014. In response, National Community Pharmacists Association (NCPA) CEO B. Douglas Hoey, RPh, MBA issued the following statement:

“Community pharmacists appreciate the steps that Medicare officials took in the final call letter to address concerns raised by NCPA member pharmacists, their patients and NCPA staff about issues that can negatively impact the program’s cost and quality of care. While CMS addressed many issues of interest for pharmacists, and NCPA has prepared a detailed analysis for its members, three principal topics stand out.

“First, egregious pharmacy audits are recouping substantial sums from community pharmacies over trivial clerical issues rather than targeting the few bad actors that may result in waste, fraud and abuse. We agree with Medicare’s statement that Part D plans should only recoup the full amount of a prescription claim under certain circumstances, such as a fraudulent or duplicate claim. When a pharmacist dispenses the right drug to the right patient for the correct cost, it should not be a punishable offense.

“Second, so-called ‘preferred pharmacy’ drug plans are creating access concerns for seniors, particularly in rural areas, by excluding many independent community pharmacies and regional chains. These plans may be increasing costs to Medicare and taxpayers as well. We appreciate Medicare’s statement that it believes that the best way to encourage price competition and to lower costs is to allow any willing pharmacy to participate in preferred networks. We hope that Part D plans will take that suggestion to heart.

“Third, auto-shipping by mail order pharmacies generates wasteful spending and inconveniences patients. As Medicare noted, community pharmacies offering drug disposal programs have documented patients turning in large quantities of unneeded medication received from auto-ship refill programs. Stronger opt-in protections for patients may deter such waste. Moreover, recent research found that community pharmacies provide 90-day medication supplies at lower cost than mail order pharmacies and that local pharmacists substitute lower-cost generic drugs more often when compared to mail order pharmacies. Plan sponsors should implement neutral co-pay designs that foster competition among all pharmacies based on service, to the benefit of patients, rather than trying to steer patients to mail order.

“NCPA staff and members will continue to work constructively with Medicare, Congress and others to maximize the health outcomes and cost-efficiency of the Medicare prescription drug program. NCPA thanks its community pharmacist members and their patients who have weighed in with Medicare officials regarding these issues in the weeks and months leading up to the final 2014 call letter.”
Related Articles
Pharmacists are getting closer to obtaining provider status, as federal legislation that would enable pharmacists to provide health care services to Medicare patients in underserved communities has been reintroduced in the US Senate and House of Representatives.
Leaders of Senate and House committees with health care jurisdiction should hold oversight hearings to examine the issues that plagued approximately 50,000 beneficiaries who are covered by Aetna Medicare Part D drug plans.
Community pharmacists are most concerned about below-cost reimbursement for certain generic drugs as well as exclusionary Medicare drug plans according to a survey conducted by the National Community Pharmacists Association that asked its members to help identify the organization’s 2015 priorities.
The National Community Pharmacists Association today announced its 2015 line-up of Ownership Workshops and Front-End Profit Building Seminars, educational programming designed for future community pharmacy owners or current owners looking to strengthen their management and merchandising skills.
Latest Issues
  • photo
    Pharmacy Times
    photo
    Health-System Edition
    photo
    Directions in Pharmacy
    photo
    OTC Guide
    photo
    Generic Supplements
  • photo
    Pharmacy Careers
    photo
    Specialty Pharmacy Times
    photo
    Generic
$auto_registration$