NCPA Commends Medicare Steps on Generic Drug Reimbursement; Urges Congress to Enact Any Willing Pharmacy Law

Published Online: Tuesday, May 20, 2014
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ALEXANDRIA, Va. (May 20, 2014)National Community Pharmacists Association (NCPA) CEO B. Douglas Hoey, RPh, MBA issued the following statement today in response to the Centers for Medicare & Medicaid Services’ (CMS) final rule for 2015 Part D prescription drug plans:

“NCPA is still reviewing the final CMS rule but we have some initial observations. “First, we commend CMS for requiring plan sponsors to both disclose to pharmacies the maximum allowable cost (MAC) reimbursement limits for many generic drugs and to update MAC-based reimbursement every seven days to better reflect market costs.

“MAC is the black box of pharmacy reimbursement. Currently community pharmacies are forced to sign take-it-or-leave-it contracts with giant pharmacy benefit managers (PBMs) without knowing their reimbursement rates for most drugs dispensed. Moreover, the cost of scores of generics is skyrocketing 1,000% or more virtually overnight, but the PBMs may wait months before updating reimbursement. That leaves community pharmacies with unsustainable losses of $60 to $100 or more per prescription. In an era of instant communication such payment update delays are indefensible and threaten the ability of community pharmacies to stay open and serve patients.

“While we would prefer that this provision take effect prior to the 2016 plan year, we appreciate CMS finalizing this provision that will provide pharmacists with critical information about how they will be reimbursed for generic drugs. CMS heard the concerns of many community pharmacies and rejected the misleading arguments made by those opposing this portion of the rule. NCPA has worked for years to alert Medicare, Congress and state legislators about these problems. Twelve states have enacted MAC laws to date.

“Second, although CMS is not moving forward at this time to give seniors more pharmacy choice and open up exclusionary ‘preferred’ pharmacy networks to more competition, NCPA appreciates the agency’s comments in support of an ‘any willing pharmacy’ policy for PDPs. NCPA encourages CMS to continue to closely scrutinize these arrangements, including whether they may be discriminatory against certain beneficiaries.

“In light of CMS’ current position, Congress should enact The Ensuring Seniors Access to Local Pharmacies Act (H.R. 4577). This bipartisan bill would give seniors more choice and easier access to discounted, or ‘preferred,’ co-pays by allowing community pharmacies located in medically underserved areas to participate in all Medicare Part D drug plan networks.

“NCPA will continue to work constructively with CMS and Members of Congress on both sides of the aisle on these and other pro-patient, pro-pharmacist issues.”
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