Congressman’s Letter Adds to Concerns about “Preferred Pharmacy” Medicare Drug Plans

Significant Congressional concern continues regarding patient and pharmacist complaints about “preferred network” drug plans in the Medicare Part D benefit, judging by a recent letter sent by U.S. Rep. Tim Ryan (D-Ohio) to Medicare.

“Over the last few months I have been hearing increasing concerns from Medicare beneficiaries and small business owners in my congressional district regarding Medicare Part D plans that feature preferred pharmacy networks,” Rep. Ryan wrote. “As these networks grow and expand in number, I am concerned that they could lead to a decrease in access to quality care and threaten the survival of small business pharmacies that play a vital role in our communities.”

Noting that Medicare’s own 2014 “call letter” suggested that its costs may be higher in preferred networks than in non-preferred networks, he added, “It would only seem fair to at least give an independent pharmacy the opportunity to try and compete with large network players.” NCPA’s staff analysis also found the full cost of many drugs to be higher in preferred pharmacy plans than in non-preferred pharmacy plans.

Confusing and misleading marketing tactics that may be associated with these plans also concern Ryan. “Unfortunately we have heard many cases where the patient had no idea that they would have to drive extended distances, sometimes even to a neighboring county, to find a pharmacy that is included in these preferred networks,” he wrote. “Not only does travel cost these seniors money, but for many Medicare patients driving long distances is not easy or even possible for some without transportation.”

In closing, Ryan asked Medicare to respond with its plans to reduce hardship among patients and pharmacy small business owners; to make sure small pharmacies can participate in preferred networks; and to ensure patients know what distances they might have to travel to have their prescriptions filled at a plan’s preferred pharmacy.

In addition to concerns expressed by Medicare, earlier this year 19 U.S. Senators, 31 U.S. Representatives and MedPAC have all raised questions about preferred network plans.

NCPA commends Rep. Ryan for his concern and continues to advocate that any legitimate pharmacy provider willing to accept a health plan’s terms and conditions should be allowed to fully participate, including as a “preferred pharmacy.”

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