Medicare Chief Queried on Medicare Part D Preferred Pharmacy Plans

Concerns over Medicare “preferred pharmacy” drug plans have now reached Medicare’s top executive and another U.S. Senator.

In recent months, significant questions have been mounting regarding preferred pharmacy plans in the Medicare Part D drug benefit. They have been expressed by patients, community pharmacists (including NCPA), 30+ Members of Congress and a key congressional advisory panel known as the Medicare Payment Advisory Commission. Most recently, they played out at a U.S. Senate Finance Committee hearing April 9 concerning the nomination of Marilyn Tavenner to be the Administrator for the U.S. Centers for Medicare & Medicaid Services (CMS), the agency that runs Medicare.

Specifically, U.S. Senator John Thune (R-SD) posed questions about the controversy to Ms. Tavenner, who currently serves as Acting Administrator.

“The other question that I wanted to raise with you is that I’ve been hearing from constituents back in South Dakota about the preferred pharmacy networks in the Part D program,” Sen. Thune stated. “For some seniors, they’re not even aware of the preferred network until after open enrollment for Part D. And for some seniors, it means the drug plan that they’ve been using for several years has changed, and those changes increase copays to go to their regular pharmacy instead of their new pharmacy in the new preferred network.

“For some pharmacies this is having an adverse impact—as you might expect—on their client base,” he continued. “And I’d like to know what’s been done to ensure that seniors are aware of the impact of choosing a Part D drug plan with a preferred network and what that might mean in terms of them being able to access their pharmaceutical services from the pharmacy that they’ve been using previously.”

For her part, Ms. Tavenner, indicated that she didn’t fully appreciate the problems surrounding preferred pharmacy plans until now.

“Senator Thune, after we talked about this one yesterday, I went back and did a little homework in this area,” she answered. “I think we certainly try to educate beneficiaries about the plan they’re in and what that’s involved, what pharmacies are in the network, but we need to do more in that area, obviously, if beneficiaries are still confused. That’s the first area.

“The second area based on your feedback is we need to take a look at the policy, and see if there are changes that we can make in the policy in the future that might make it a little easier on this issue. I appreciate that. I was not as aware of this issue until we talked, so I appreciate that,” she concluded.

Most Medicare preferred pharmacy plans do not allow independently owned pharmacies to participate as a preferred pharmacy in their network. This creates a challenge for seniors in rural areas, where independent or regional pharmacies are often the closest pharmacy and where the nearest preferred pharmacy may be 20 miles or more away.

Cost concerns have also come into play. A pricing comparison by NCPA staff found many instances in which preferred pharmacies were more expensive than non-preferred ones, according to Medicare’s Plan Finder website. Recently Medicare officials voiced similar questions.

NCPA will continue working and advocating for changes to give these patients greater choice and access to independent community pharmacies.

3 Responses to “Medicare Chief Queried on Medicare Part D Preferred Pharmacy Plans”

  1. 1 Norman W. Davis April 11, 2013 at 7:55 pm

    While they’re “taking a look” they should order a cease and desist order until the full impact is ascertained. Waiting until next year is going to be too late for some of us.

  2. 2 Van G. Coble Dph, CDM, FASCP April 11, 2013 at 10:04 pm

    It appears that we may have the attention of CMS. Independent pharmacies need to keep the pressure on CMS, particularly by contacting the senators and their representative.

  3. 3 Jim Fields RPh April 12, 2013 at 8:12 am

    The truth as clearly stated in a recent PCMA release is that PBMs have concluded that there is more profit for them to pay the “fines” for not supplying mandated geographic coverage and limit access for the patients thru selective contracting.

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