Poll: Over One Million Seniors Have Problems with Medicare â€˜Preferred Pharmacy' Drug Plans
May 20, 2013 (Alexandria, Va.) - National Community Pharmacists Association (NCPA) CEO B. Douglas Hoey, RPh, MBA issued the following statement today regarding a survey by Hart Research Associates regarding Medicare Part D “preferred pharmacy” drug plans, which often exclude independent community pharmacies from offering patients the plan’s lowest advertised co-payments:
“Officials with Medicare and MedPAC, 16 U.S. Senators and more than 30 U.S. Representatives have all expressed concerns with Medicare preferred pharmacy drug plans and for good reason. They create access concerns for some patients and may be increasing costs for Medicare and taxpayers.
“First, in rural areas seniors in these plans may have to travel 20 miles or more to obtain their prescription drugs. Independent community pharmacists in these areas report that patients are repeatedly dealing with this barrier to obtaining their medications. Perhaps reflecting this problem, more than one million seniors are either very dissatisfied or somewhat dissatisfied with their preferred pharmacy Medicare drug plan1.
“Second, Medicare and taxpayers may not realize any overall savings from these prescription drug plans (or PDPs). As Medicare said in its proposed 2014 call letter, ‘We have begun to scrutinize Part D drug costs in PDPs with preferred networks, and comparing these to costs in the non-preferred networks, as well as to costs in PDPs without preferred networks. We are concerned because our initial results suggest that aggregate unit costs weighted by utilization (for the top 25 brand and top 25 generic drugs) may be higher in preferred networks than in non-preferred networks in some plans [emphasis added]. Combined with lower cost sharing, we believe these higher unit costs may violate the requirement not to increase payments to such plans.’
“An analysis by NCPA staff backs up Medicare’s concerns. NCPA staff looked at four common drugs (generic version of Lipitor—atorvastatin calcium Tab 20mg 90 day supply; generic version of Plavix—clopidogrel Tab 75mg 90 day supply; Diovan—Tab 80mg 90 day supply; and Nexium—Cap 40mg 90 day supply) on Medicare’s Plan Finder website. Looking at two large preferred pharmacy plans (AARP MedicareRx Preferred and Humana Walmart Preferred Rx), the cost of the drugs was compared between preferred pharmacies, mail order pharmacies and non-preferred pharmacies in eight cities (Helena, MT; Salt Lake City, UT; Pierre, SD; Cheyenne, WY; Boise, ID; Denver, CO; Salem, OR; and Des Moines, IA). Across the eight cities, the Plan Finder full cost of the preferred network pharmacy was more expensive than the Plan Finder full cost of the non-preferred network pharmacy 75 percent of the time. Furthermore, the Plan Finder full cost when comparing mail pharmacy to a non-preferred network pharmacy, was again higher 94 percent of the time.
“There is an easy solution to address the concerns of more than one million seniors with preferred pharmacy drug plans. Allow any legitimate pharmacy willing to accept plan terms and conditions, including reimbursement, to participate. Medicare officials have already recommended this change. In its final ‘call letter’ for 2014, the agency said it believes that the best way to encourage price competition and to lower costs is to allow any willing pharmacy to participate in preferred networks. We hope that Part D plans will take that suggestion to heart.”
1According to the Pharmaceutical Care Management Association, 9.5 million seniors are enrolled in preferred pharmacy plans and Hart Research Associates reports that 11 percent of preferred pharmacy plan beneficiaries are either somewhat dissatisfied (5%) or very dissatisfied (6%) with their plan.