Community Pharmacists Voice Concerns to Medicare over Walmart Drug Plan

The National Community Pharmacists Association registered its concerns with Medicare over the Humana Walmart Preferred-Rx Plan in a letter sent to the agency today.

Here are some key points from the letter, available in its entirety here.

• “ We believe that CMS should not have approved this Humana-Walmart plan design. In our view, the plan violates the spirit and intent of the rules and regulations surrounding the Part D program.
• “[U]nless Medicare beneficiaries rely solely on a select list of ‘preferred’ generics, they are unlikely to save much money. Many common generics are classified as non-preferred generics and, consequently, patients will pay a higher co-pay.
• “Only two of the top 15 medications most frequently prescribed to seniors are in the lowest cost tier. Three of the top 15 medications most frequently prescribed to seniors are not even on the plan’s formulary (Celebrex, Nexium, and Aricept).
• “Patients who don’t live near a Walmart would not benefit from the cost-savings of this plan since they would be forced to pay higher co-pays to have their prescriptions filled at non-Walmart pharmacies or use mail order. Long-term care residents (specifically non-LIS patients) who enroll in this plan will pay higher co-pays to have their prescriptions filled through their long-term care pharmacy than they would through a Walmart pharmacy.
• “Finally, it is a violation of the current marketing guidelines for the prescription benefit card of this program to be co-branded with the Walmart logo. … We ask that you immediately inform Humana and Walmart that the card should in no way, shape or form include the name Walmart. “[W]e believe that CMS unfortunately erred in approving this plan. We believe that approval of this plan puts the program on a dangerous path to reduced care and impaired quality. We should not let Part D become a ‘race to the bottom’. We urge CMS to reconsider its decision in this matter.”

The importance of reading the Walmart plan’s fine print was echoed in an analysis by Kiplinger’s Personal Finance. After noting the plan’s attractive premium and co-pays that only apply to preferred generics, Kiplinger’s warned, “But if you use an outside pharmacy, your co-pay for both levels of generics is $10, and you’ll pay 37% co-insurance for non-preferred generics and preferred brand-name drugs, and a whopping 50% for non-preferred brand-name drugs.”

To help community pharmacists respond to patients seeking advice on choosing the right Medicare drug plan, NCPA has developed a Medicare resource kit. The Ask Your Family Pharmacist materials are available to NCPA members free of charge. More information is available in the Medicare section of the NCPA Web site.

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