Pharmacists Ask Medicare for Action on Pharmacy Audits, Preferred Pharmacy Plan Problems

By Kevin Schweers

If Medicare officials needed further evidence as to why they should address egregious pharmacy audits, preferred pharmacy plan problems and mail order auto-shipping waste, they have received it, judging by the comments independent community pharmacists are submitting.

The U.S. Centers for Medicare and Medicaid Services (CMS) is determining the extent to which it may need to address these issues as it sets policies for 2014 Medicare Advantage and Medicare Part D prescription drug plans, or PDPs. (More background on this can be found in our earlier posts here and here.) Up until 6 p.m. ET March 1, CMS is accepting comments in response to its proposed policies (or “call letter”).

“Having practiced for nearly 40 years, I have never experienced the personal barrage of calls from my patients; exasperated that they were FORCED to switch from Hartig’s to Wal-Mart, Walgreen’s or Hy-Vee Grocery store because they signed up for a Med D Plan that they believed Hartig’s participated in,” wrote Richard J. Hartig, RPh, MBA of Dubuque, Iowa’s Hartig Drug Company, Inc. “One after another, they explained to me, ‘Dick the web site said that Hartig’s was in their network; that’s why I chose the plan.’ Sure, Hartig’s (my company) is listed as a participating pharmacy….but NOT a PREFERRED PARTICIPATING PHARMACY!”

He continued, “Fast forward. So I began losing patients by the thousands because of co-pay differentials, mandatory mail order plans, and just downright nasty responses from preferred network PDP’s that declined my request to join their networks … They all had the same response – we’ll let you know if and when we need to add pharmacies to our preferred network.”

“Elderly patients still need face-to-face time with a pharmacist,” Hartig concluded. “They have questions and, from time to time will require special packaging or a delivery due to illness. Many patients I have heard from are not pleased but also very wary about how to go about switching plans. They are very nervous when it comes to anything having to do with their Medicare plan. Mostly they say, ‘I don’t want to lose it.’ Please consider opening up to the seniors in our society the opportunity to choose their pharmacist based on the services that they receive.”

Pharmacist Mark Doyle, owner of McLanahan Drug Store in Centre Hall, Pa., wrote, “Preferred Pharmacy Networks: My store was not even offered the chance to participate in these networks and so my customers either have to pay higher co-pays at my store or travel 15 to 20 miles further to get their meds. We should have at least been offered the chance to participate.”

He added, “The marketing of these networks is less than honest as many times the peoples’ copays are the same everywhere, especially the [Low Income Subsidy or LIS] programs where their out of pocket expense is the same everywhere, yet because of the confusing information they get they are driving long distances for no reason. Both Medicare and its beneficiaries are being deceived and neither is saving money.

“Automatic Prescription refills: There is a huge amount of waste done by this practice both with drugs and in the Medicare Part B sector (diabetic testing supplies, catheters, ostomy products, etc.). I had a customer who gets meds and test strips bring in about $2,000 worth of product and asked me what to do. They continued to mail him drugs that he no longer was using, and the test meter they supplied him stopped working and he called and told them 5 times, yet they continued to mail him the same things month after month.

“Pharmacy audits by these PBMs have been unregulated and very one-sided. They should be regulated and made fair to all concerns. Routine clerical errors should not be used to deny payment of fair claims. I never fear audits that are fairly performed; they should be done to protect all of us.”

Community pharmacists and others have until 6 p.m. ET Friday, March 1 to contact Medicare officials about this. Anyone can do so by clicking here. NCPA’s sample letter is available (here) for community pharmacists to review and then personalize with their first-hand observations. In addition, NCPA will submit comments.

2 Responses to “Pharmacists Ask Medicare for Action on Pharmacy Audits, Preferred Pharmacy Plan Problems”

  1. 1 James Cobb March 1, 2013 at 12:35 pm

    Independent retail pharmacies need one PSAO; approved, structured and governed for the benefit of the pharmacist. Voting power and contract compliance controlled by the pharmacist and related buying groups. The top fifteen buying groups need to be join immediately with a preamble- we govern and act as one!
    The independent retail pharmacy has been eliminated from Plan D preferred networks and probably the same will happen with ACO’s and Part A and B. This is a short-sided and systematic elimination by the CMS under the Affordable Care Act in the name of cost savings/sharing. In reality, the retail pharmacy is needed more than ever as the ACA provides twenty-five million new drug patients.
    The same holds true of state Medicaid and managed care contracting. One PSAO with the authority to contract for all independent retail pharmacies would politically have the influence to effectuate change in networks and contracts. A level playing field is a must for all involved within the healthcare system.

  1. 1 NCPA Seeks Continued Medicare Action on Patient, Pharmacist Concerns | NCPA's The Dose - The Voice of the Community Pharmacist Trackback on April 9, 2013 at 8:34 am

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