NCPA Suggests Hearing on Harm to Community Pharmacies, Patients from ‘Preferred Pharmacy' Medicare Drug Plans



ALEXANDRIA, Va. (Mar. 25, 2014) — The Senate and House Small Business Committees should hold a hearing looking into the unintended consequences for patients and independent community pharmacies that have resulted from Medicare Part D “preferred pharmacy” prescription drug plans, the National Community Pharmacists Association (NCPA) wrote in a letter to lawmakers today.

In early 2014, the Centers for Medicare & Medicaid Services (CMS) proposed allowing any pharmacy willing to accept the requisite contractual terms and conditions to participate as a drug plan’s “preferred” pharmacy. This patient choice proposal received support from dozens of members of Congress from both parties [including House Small Business Committee Chair Sam Graves (R-Mo.)] and key Medicare beneficiary advocates, but was set aside by CMS March 10 largely as a result of political opposition to other, unrelated provisions contained in the agency’s broader proposed rule.

“Over the last several years we have heard increasing concern from our small business owner members in regards to being excluded from participating in Medicare Part D preferred pharmacy networks,” NCPA CEO B. Douglas Hoey, RPh, MBA wrote in the letter. “Many of our members are suffering due to unintended consequences. Small business community pharmacies across the country are losing patients due to their inadvertent exclusion from these preferred networks. Additionally, CMS itself has released data showing that these networks, in their current form, might not even be saving money for the federal government.”

Hoey continued, “We request that you schedule an oversight hearing to determine what changes need to be made to the statute in order to level the playing field for independent community pharmacies. As you know, our members serve a disproportionate share of Medicare patients in highly rural and low-income urban areas across the country; therefore it is critical that Congress continue to work to eliminate any barriers which may result in a disruption of care, counseling, or access to medications for these patients.”

Members of Congress who voiced support earlier this year for the patient choice (or “any willing pharmacy”) proposal include Reps. Robert Aderholt (R-Ala.); Spencer Bachus (R-Ala.); Lou Barletta (R-Pa.); Earl Blumenauer (D-Ore.); Bradley Byrne (R-Ala.); Shelley Moore Capito (R-W.Va.); Kathy Castor (D-Fla.); Doug Collins (R-Ga.); Kevin Cramer (R-N.D.); Sam Farr (D-Calif.); House Judiciary Committee Chair Bob Goodlatte (R-Va.); Trey Gowdy (R-S.C.); House Small Business Committee Chair Sam Graves (R-Mo.); Morgan Griffith (R-Va.); Gene Green (D-Texas); Ruben Hinojosa (D-Texas); Walter Jones (R-N.C.); Peter King (R-N.Y.); Dan Lipinski (D-Ill.); Dave Loebsack (D-Iowa); Dan Maffei (D-N.Y.); Thomas Massie (R-Ky.); Bill Owens (D-N.Y.); Collin Peterson (D-Minn.); Phil Roe (R-Tenn.); Mike Rogers (R-Ala.); Tim Ryan (D-Ohio); John Sarbanes (D-Md.); Terri Sewell (D-Ala.); House Energy and Commerce Committee Ranking Member Henry Waxman (D-Calif.); Peter Welch (D-Vt.); and Lynn Westmoreland (R-Ga.).

Key consumer advocates support patient choice as well, including the Alliance for Retired Americans; American Federation of State, County and Municipal Employees (AFSCME); California Health Advocates; Center for Medicare Advocacy, Inc.; Families USA; Medicare Rights Center; National Committee to Preserve Social Security and Medicare; National Council on Aging; Service Employees International Union (SEIU); and National Senior Citizens Law Center.

“When the Part D law was first enacted, there was no need for any small business set aside, because it included an ‘any willing provider’ provision that mandated that any pharmacy willing to accept the terms and conditions of a plan could participate,” Hoey added. “Now, as a result of CMS’s faulty interpretation of this provision, small businesses need Congress to act more than ever.”

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