NCPA Speaks Up for Patient Choice of Pharmacy in Medicare Lock-in Program



The National Community Pharmacists Association (NCPA) recently submitted comments to the Centers for Medicare and Medicaid Services (CMS) regarding the implementation of Sec. 704 (also known as the pharmacy "lock-in" provision) in the Comprehensive Addiction and Recovery Act of 2016 (CARA). At-risk Medicare Part D beneficiaries are the target of this initiative, trying to stem the rise of opioid abuse, which will officially begin in 2019.

"NCPA worked in a bipartisan, bicameral fashion to ensure that the need to address the abuse of opioids among seniors did not create undue hardships in accessing prescription painkillers," said NCPA CEO B. Douglas Hoey, RPh, MBA. "However, we do have lingering concerns that we expressed to CMS to ensure the implementation process runs as smoothly as possible."

NCPA addressed several areas where independent community pharmacies and the patients they serve could be adversely affected without further clarification from CMS:

  • Besides opioids, NCPA recommends that no other scheduled drugs be considered for the program at its inception. NCPA appreciates that CMS has historically required plans take a step-wise approach to prevent overutilization. In this same manner, NCPA asked that CMS limit the list of frequently abused drugs for lock-in purposes.
  • Residents of assisted living facilities (ALFs) and patients under a doctor's care for treatment of cancer or related conditions should be exempt from the lock-in provision. To require these patients receive pharmacy services from an outside provider is not feasible and leads to disconnects in care.
  • Notices sent to patients placed in the lock-in program by plans/PBMs should make clear the program only applies to opioids, so patients are not confused and believe they have to have all prescriptions filled at the lock-in pharmacy. In addition, patient lock-in status should be shared with current prescribers and pharmacies, including duration of the "lock-in" and specific medications impacted.
  • Since preference only is to be considered by plans/PBMs when delegating prescriber/pharmacy for purposes of the Part D lock-in program, there must be protections in place for continual access. Unlike similar "lock-in" programs that currently exist in state Medicaid programs, PDP plan sponsors will have unprecedented control over these programs in Part D and CMS must address potential plan/PBM "conflicts of interest" since there are multiple PDP sponsors that have existing commercial relationships with large retail pharmacy chains. In no way should plans/PBMs be able to assign patients to those pharmacies in which they have a financial stake.

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