19th U.S. Senator Questions Medicare Part D Preferred Pharmacy Plans


By Kevin Schweers

U.S. Sen. Mary Landrieu (D-La.) recently became the 19th United States Senator to go on record expressing concerns over the impact of Medicare “preferred pharmacy” drug plans on Medicare, taxpayers, seniors and small-business community pharmacies.

In addition to the Senators, more than 30 Members of Congress, MedPAC and Medicare officials themselves have expressed concerns regarding these plans, which have proliferated. Seniors in these plans may have to travel 20+ miles to obtain their prescription drugs in exchange for little, if any, overall savings.

After the Louisiana Independent Pharmacies Association (LIPA) raised these issues, Sen. Landrieu wrote to Medicare.

“I am concerned that these networks may increase Medicare Part D costs and negatively impact Medicare beneficiaries’ access to pharmacies, especially in rural areas,” wrote Landrieu, who is also a cosponsor of S. 557, legislation to expand utilization of medication therapy management services in Medicare to improve health outcomes. She added, “I ask that you implement increased oversight of Medicare plans with preferred networks to minimize potential risks.”

Moreover, a pricing comparison of commonly used drugs shows many instances in which preferred pharmacy plans had higher total costs than traditional, non-preferred plans, according to Medicare’s Plan Finder website. Medicare officials are examining the cost discrepancies.

In the view of Medicare, NCPA and others, any legitimate pharmacy willing to accept plan terms and conditions, including reimbursement, should be allowed to participate.

7 Responses to “19th U.S. Senator Questions Medicare Part D Preferred Pharmacy Plans”


  1. 1 Theodore R. Parker, R.Ph., MPH June 5, 2013 at 12:30 am

    I really hope somethings happens with this. As a community pharmacy in the Northern Marianas Islands, we were left completely out. The only preferred pharmacy for our patients is in Hawaii, 9 hours away by plane. I appealed to CMS and even offered to match the reimbursement rate. I was told that being in the preferred network was “by invitation only” and was denied.

    • 2 ncpa1 June 6, 2013 at 9:11 am

      That’s outrageous. Thank you for sharing your story. NCPA will continue to advocate for patients and pharmacies like yours. Hopefully the recent and increasing interest in this issue from Senators, Representatives, MedPAC and even Medicare itself is the beginning of some positive change on this.

  2. 3 Carol Bylone June 5, 2013 at 9:13 am

    As of January,2013 I not only became a Medicare D patient but also am a practicing community pharmacist. I enrolled in AARP’s Medicare D program & was never made aware of the fact that this program is now a preferred pharmacy network program nor was the pharmacy I am affiliated with ever offered the opportunity to become part of the AARP preferred network which I find outrageous! All of this information was received AFTER I was enrolled & my booklet of information came to me as the Medicare D patient. The closest preferred network pharmacy to me is 30 miles from where I live. It is part of a large chain pharmacy that I do not want to use partly because of the distance & primarily because it is a large chain operation. I prefer a smaller patient friendly operation like the pharmacy in which I work and have earned income from for the past 15 years. They’ve earned my loyalty for a multitude of reasons. All pharmacies irregardless of size & location should have the opportunity to participate in these federally funded programs made available with all of our taxpayer dollars, not just the dollars of the big chains. Based upon years of experience in healthcare, the only individuals benefitting from these preferred networks are the businesses included within the networks, certainly not the patients nor the federal government. What happened to the law that specifically allows Medicare D patients to utilize whatever pharmacy they choose without penalty??? Higher copays in non-preferred network pharmacies certainly are a penalty as well as traveling 30 miles at the cost of travel expense today to get to the pharmacy & heaven only knows how long to wait for service. Time and travel are precious commodities in today’s economic world and even more costly for the average senior citizen living on a fixed income.

    • 4 jpf June 5, 2013 at 4:53 pm

      I agree completely and I have been a pharmacy owner for over 29 years. . I have a few years before I need Medicare D, but it has many problems as it has evolved since it’s inception in 2006. When it started, there was supposed to be a level playing field among the pharmacies and even the PBM’s. It has slowly changed to an ugly, dog eat dog, insurance debacle. I was told that I can’t “steer” any patient to any certain Med D plan or face penalties, but you walk into a WalMart now and run into a Humana booth selling Med D plans and get your medicine there with a cheaper copay than with me. You go to CVS and they steer you to one of their Caremark plans. The mail order provision was originally left out of Med D but has some how managed to get put into place with many PBM’s. That is my biggest competition now. It’s hard to fight when I don’t even know that the PBM’s are sending letters to my patients telling them they “have” to go mail order. I’m mad as hell over this debacle and our pharmacy organizations are weak and can’t (won’t) fight hard enough to help us. The pharmaceutical manufacturers are in bed with the PBM’s and have much deeper pockets (lobbyists) than we do. Ugh. Help…..someone!!! jpf

      • 5 ncpa1 June 7, 2013 at 8:33 am

        You are correct in that pharmacists and patients alike face many inequities in Medicare Part D as it’s currently run. NCPA has consistently advocated to Medicare, Congress and others about these problems, on behalf of its member community pharmacists and their patients. As a result, there has been a welcome increase in the number of people looking specifically into the preferred pharmacy plan problems, as the blog post above describes. Hopefully this is a sign of some coming change and NCPA will continue to advocate.

    • 6 Robert Randall June 6, 2013 at 1:31 am

      Carol,

      Is this an admission that AARP’s offering was not researched before buying the product? Since all AARP offers is Medicare part D with PDP then this is not the right choice. Open enrollment will fix the problem at the personal level.

      It is easy and fast to use medicare.gov to find a plan that includes all one’s medications that are covered by the pharmacies that user selects. The plan choices are rated and detail on specific drug coverage, plan premiums and more is all laid out for an educated choice.

      Small pharmacy operations are likely to lose out that is true. However, wait and see if Medicare Part D that utilize only PDP, like AARP, have to raise the premium. I suspect they will as there is already evidence that PDPs are failing to deliver cost savings claimed.

    • 7 ncpa1 June 6, 2013 at 9:12 am

      Yes, this is a common refrain we continue to hear. Plenty of questions as to how these plans are marketed. In response to your specific question about “any willing provider” requirement, NCPA and others have raised that. Unfortunately, to date Medicare has interpreted any willing provider as not applying to these preferred pharmacy plans. More info on that is available in the Member Only section of the NCPA website in a comprehensive frequently asked questions document. Hopefully the recent groundswell of opposition to these plans will lead to some positive change. Thank you for sharing your story to help raise awareness.


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