NCPA Rx for Exchange Plans: More Pharmacy Choice

December 23, 2014

The National Community Pharmacists Association supports new proposed protections of patient choice of pharmacy and urges federal officials, in comments filed recently, to take additional steps to support broader consumer protection at no added cost.

PRESS RELEASEALEXANDRIA, Va. (Dec. 23, 2014) — The National Community Pharmacists Association (NCPA) supports new proposed protections of patient choice of pharmacy and urges federal officials, in comments filed recently, to take additional steps to support broader consumer protection at no added cost.

NCPA’s comments come in response to a range of new requirements and recommendations proposed by the Centers for Medicare & Medicaid Services (CMS) for health insurance plans that operate in the exchanges established by the Affordable Care Act (or Obamacare). The changes, if implemented, would apply to the 2016 plan year.

“We strongly support the proposed requirement that enrollees be provided with the option to access their prescription drug benefit through retail (bricks and mortar or non-mail order pharmacies) and that plans cannot have a mail order only prescription drug benefit,” urged NCPA Vice President for Policy & Regulatory Affairs Susan Pilch, JD. “In addition, we would like to propose that an additional provision be included that would allow a retail pharmacy to charge the same copay as the mail order pharmacy as long as the retail pharmacy agrees to accept the same reimbursement as the mail order pharmacy.”

Other highlights of NCPA’s comments to CMS include the following:

  • 90-day at retail - Plans that offer 90-day drug fills at mail order should be required to also offer 90-day drug fills at retail network pharmacies. Many times, community pharmacies are willing to do so, at the same net cost to the health plan, but may be blocked from doing so by plan intermediaries known as pharmacy benefit managers (PBMs), many of which have a vested financial interest in establishing plan benefit designs that unfairly advantage their own mail order pharmacies.
  • Specialty drugs - NCPA supports added protections for patients who wish to obtain “specialty drugs” from their community pharmacist instead of the PBM’s mail order pharmacy.
  • Network adequacy improvements - Plans should update their listings of in-network providers more frequently, as CMS proposed. In addition, plans should allow the participation of all pharmacies willing to accept the requisite terms and conditions; and the TRICARE/Medicare Part D retail pharmacy access standards should apply to exchange plans as a minimum threshold for network adequacy, including any “preferred” networks of pharmacies authorized to offer further discounts.
  • 30-day transition — NCPA agrees with CMS recommendation that plans more broadly cover services in the 30-day transition period as patients assimilate to a new plan.

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