The “Lock-In” Pharmacy Approach to Rx Drug Abuse

By Kevin Schweers

A proposal to restrict certain Medicare beneficiaries to use only a dedicated, “lock-in” pharmacy for their controlled substances is now a part of legislation introduced by two House lawmakers.

Washington DCHouse Ways and Means Health Subcommittee Chair Kevin Brady (R-Texas) and Ranking Member Jim McDermott (D-Wash.) recently proposed the Protecting the Integrity of Medicare Act (PIMA). The broad bill is comprised of a range of proposals intended to reduce Medicare fraud, waste and abuse. Its features include the “lock-in” pharmacy idea.

NCPA appreciates the Representatives’ leadership and intent to safeguard Medicare dollars. NCPA staff will review the proposed legislation. NCPA was among the stakeholder groups that provided input to the subcommittee during the summer on a draft discussion bill, and we’re pleased to see that the most recent version is more encompassing in terms of beneficiary choice in prescriber and pharmacy.

Regarding the “lock-in” pharmacy concept generally, such a system must be a level playing field for independent community pharmacies. Patients should not be locked against their will into a pharmacy they don’t want to use or into mail order pharmacies, most if not all of which are owned by the pharmacy benefit managers (PBMs) running Medicare drug plans. (That’s a conflict-of-interest in itself.)

Mail order often sends 90-day supply shipments and to ship such large amounts through the mail seems particularly inappropriate for controlled substances prone to addiction.

The prescription drug abuse epidemic is complex and wide-ranging in nature. NCPA supports a collective approach to controlling abuse and diversion that involves everyone: patient, pharmacist, PBM, wholesaler, manufacturer, and prescriber.

At the forefront of prevention efforts must be a focus on reducing inappropriate prescribing of controlled substances and prevention of doctor shopping. After all without the prescription, a prescription drug abuser cannot advance any further through the legitimate health system, such as to a pharmacy.

Also as the concept of a “medical home” becomes more important, pharmacy is a key component. When a patient chooses one location for a “pharmacy home”, the pharmacist is aware of the patient’s complete medication picture and can better look out for drug interactions and promote patient adherence to their prescribed medication. A 2013 national survey identified the extent to which patients have a connection to their pharmacist or pharmacy staff as the leading indicator for medication adherence.

Any “lock-in” approach must be carefully crafted to not undermine these and other aspects of the patient-pharmacist relationship.

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