CMS Seeks to Improve Access to Preferred Cost Sharing Pharmacies


Medicare Part D plans are increasingly creating smaller networks of pharmacies within larger networks that offer lower cost-sharing arrangements.

The Centers for Medicare Medicare & Medicaid Services (CMS) is prioritizing an effort to make preferred cost sharing pharmacies available in geographical areas that have little access.

“Last year, we heard concerns that some beneficiaries did not have ready geographic access to preferred cost-sharing pharmacies,” Deputy Administrator and Director of CMS Sean Cavanaugh wrote in a blog post. “Increasingly, Part D plans are creating smaller networks of pharmacies within their larger networks and offering lower cost-sharing arrangements to beneficiaries who use these preferred cost-sharing pharmacies.”

Although plans are marketed with lower cost-sharing arrangements, there are some areas that do not have pharmacies accessible to beneficiaries.

The results of an analysis of Part D beneficiary access released in April 2015, found that there was a large portion of Part D enrollees who live in areas where the plans provide preferred cost-sharing pharmacy networks.

However it was found that beneficiaries, mostly in urban areas, had limited or no geographic access to preferred cost-sharing pharmacies.

In order to address this issue, CMS laid out a plan to help in these areas.

The plan includes measures such as:

  • Working with outlier plans that addressed concerns regarding marketing and access
  • Require the discloser in marketing material of plans offering less access to preferred cost-sharing pharmacies
  • Publish access levels that offer a benefit structure for each plan.

“We are pleased to share that, based on data we are posting on today, access to preferred cost-sharing pharmacies has improved,” Cavanaugh wrote. “The bottom 10th percentile of plans in 2016 offer access within two miles to 71% of urban beneficiaries, as compared to 40% of beneficiaries in 2014.”

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