Alexandria, Va. February 7, 2013 - A survey of community pharmacists suggests that so-called "preferred pharmacy" Medicare Part D drug benefit plans may pose challenges for seniors in rural communities. The finding comes shortly after similar questions were raised at the January public meeting of the Medicare Payment Advisory Commission (MedPAC), Congress' advisory board on Medicare issues.
The National Community Pharmacists Association (NCPA) surveyed 400 pharmacists in January 2013 regarding the plans. Among the findings:
While the Medicare Part D program does require plans to maintain a pharmacy network that meets minimum access standards, these requirements do not apply to the preferred pharmacies designated by the plan. To date, plans have largely designated only national chain pharmacies as preferred pharmacies, raising access concerns for rural seniors. Approximately 1,800 rural independent pharmacies serve as the only pharmacy provider in their community, with the next closest pharmacy many miles away.
"Any legitimate pharmacy provider willing to accept a health plan's terms and conditions, including reimbursement, should be allowed the opportunity to serve that plan's members, including as a preferred pharmacy," said NCPA CEO B. Douglas Hoey, RPh, MBA. "That means more choice for patients and competition on service. Unfortunately, in the current environment, seniors may unwittingly be coerced by co-pays that are only available in 'preferred' pharmacies that may be 20 miles away, while much-closer, locally owned pharmacies are shut out. In effect, Medicare's access standard is a double standard—one by which some plans rely on independent pharmacies to meet pharmacy network access requirements while not allowing those same pharmacies to serve patients on equal footing."
At the Jan. 10 MedPAC meeting, Commission staff said one reason they were "keeping an eye on this trend is because this could have an effect on beneficiaries' access to medications." In particular, questions were raised at the meeting about preferred pharmacy plans' potential impact on patient access to medication, beneficiary confusion over the difference between a preferred pharmacy and a network one, and the cost impact of differential co-pay levels. "Access and cost implications of tiered pharmacy networks are not yet known and we will continue to monitor the plans' use of tiered pharmacy networks and the effects on beneficiaries' access to medications," MedPAC staff noted.
Pharmacists responding to the survey offered additional comments, including the following: