U.S. Reps. Contact Medicare in Support of Proposed Changes for 2015 Drug Plans

Published Online: Wednesday, February 12, 2014
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ALEXANDRIA, Va. (Feb. 12, 2014) – Members of Congress are contacting the U.S. Centers for Medicare & Medicaid Services (CMS) in support of pro-patient improvements the agency proposed for Medicare Part D prescription drug plans (PDPs) in 2015, a development applauded today by the National Community Pharmacists Association (NCPA).

In response to problems with “preferred pharmacy” networks, CMS has proposed allowing any willing pharmacy to offer a plan’s lowest, or preferred, cost-sharing to give seniors more choice and to foster greater competition among pharmacies.

U.S. Representatives Mike Rogers (R-Ala.) and Lynn Westmoreland (R-Ga.) have written to CMS to back the change.

“I was encouraged to hear that the proposed rule for Part D dealt with many of the concerns that [community pharmacists] shared with me,” Rep. Rogers wrote. “Not only were these community pharmacies not allowed to even try and compete with lower co-pays that larger stores can offer, but many seniors signed up for these plans not realizing they would no longer be able to continue using their community pharmacy after signing up.”

Rep. Westmoreland wrote to CMS that, “Your agency’s recent release of its proposed rule on Part D has some very encouraging language that addresses” concerns raised by community pharmacists and patients, adding that “I believe the work is not yet complete and that it is crucial that Congress and the Executive Branch make sure small business pharmacies have the ability to compete on a level playing field with all the entities involved.”

Both lawmakers represent rural communities and noted that independent community pharmacies often serve such areas where national chain pharmacies may not exist.

“We commend these lawmakers for voicing their support on behalf of their constituents for the common-sense enhancements that Medicare has proposed for drug plans next year,” said NCPA CEO B. Douglas Hoey, RPh, MBA. “Patients will benefit from more choice and competition among pharmacies if CMS’ proposal is made final. Independent community pharmacies deserve the opportunity to match the contract terms and conditions, including pricing, of ‘preferred’ pharmacies. As Medicare officials have noted, this is ‘the best way to encourage price competition and lower costs in the Part D program.’”

In March 2013, 31 U.S. representatives sent a letter to CMS to express concerns over exclusionary preferred networks in Medicare Part D. In particular, the lawmakers stated “we fear these networks could lead to a decrease in access to quality care and threaten the survival of community pharmacies” and further demanded a response from CMS. Shortly thereafter, the agency received a similar letter from 16 U.S. senators. CMS subsequently issued the proposed rule open until March 7, 2014 for public comment.

While preferred pharmacy networks have been championed by pharmacy benefit managers (PBMs) as producing astronomical cost savings, a series of analyses of Medicare data have found repeated instances where preferred pharmacy plans and PBM-owned mail order are more expensive for Medicare.
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