NCPA Asks Medicare to Address PBM Clawbacks, Narrow Pharmacy Networks, More

The National Community Pharmacists Association responded to an array of new proposals for 2017 Medicare drug plans and asked the Centers for Medicare & Medicaid Services to address some of the most pressing issues for independent community pharmacists in comments submitted in response to the CMS "Call Letter."

PRESS RELEASE

ALEXANDRIA, Va. (March 7, 2016) - The National Community Pharmacists Association (NCPA) responded to an array of new proposals for 2017 Medicare drug plans and asked the Centers for Medicare & Medicaid Services (CMS) to address some of the most pressing issues for independent community pharmacists in comments submitted in response to the CMS "Call Letter."

"The annual 'Call Letter' provides an opportunity to reflect on how the Medicare Part D program can be enhanced to work more effectively for patients and community pharmacists," said NCPA CEO B. Douglas Hoey, RPh, MBA. "NCPA urges CMS to utilize this moment to help community pharmacists on the front lines assisting patients every day. Clawbacks, or DIR fees, levied by PBM corporations are making it hard for independent pharmacies to continue operating. In addition, while some progress has been made, more disclosure and safeguards are still needed to help beneficiaries and pharmacists struggling with 'preferred pharmacy' limitations imposed by drug plans."

Highlights from NCPA comments and recommendations include passages that address the following issues:

Apply more scrutiny of and transparency into plan sponsor bids and impose financial penalties when beneficiaries and CMS "overpay" plans due to improperly accounted for direct and indirect remuneration (DIR) fees.

Support for outcomes-based medication therapy management (MTM) measurements in enhancing the Star Ratings.

Part D reporting requirements for MTM.

Better disclosure from plans with inadequate access to "preferred pharmacies" and financial penalties should plans' DIR fee arrangements result in higher costs to CMS from "preferred pharmacies."

In addition, NCPA addressed proposed specialty drug tiers, drug utilization controls for opioids and mail order protocols for urgent need fills.

After reviewing the comments received in response to its proposed Call Letter, CMS is expected to issue a final version in the next several weeks.