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

Published Online: Wednesday, April 3, 2013
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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.”
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