NCPA Input Shows in Medicare Preferred Network Disclaimer Requirements


pharmacistAbout one month after proposing disclosure language that Medicare Part D drug plans must use in marketing to beneficiaries, the Centers for Medicare & Medicaid Services (CMS) published final disclaimer language that sponsors must include in any marketing materials for 2016 plans that provide inadequate access to discounted copays at “preferred” pharmacies.

 

We wrote about CMS’ initial proposal here and followed by a post on NCPA’s recommendations to improve it

NCPA commends CMS for incorporating some of our concerns in the recently announced final disclaimer text pasted below:

“<insert organization/plan name>’s pharmacy network offers limited access to pharmacies with preferred cost sharing in <insert geographic area type(s) and state(s) for which plan is an outlier)>.  The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use.  For up-to-date information about our network pharmacies, including pharmacies with preferred cost sharing, please call<insert Member Services phone number and TTY>or consult the online pharmacy directory at <insert website>.”

Most notably it adds greater disclosure to beneficiaries as NCPA suggested. Specifically with the addition of this phrase “The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. ”

NCPA continues to strongly press for an “any willing pharmacy” solution to the prescription drug access and pharmacy choice problems raised by “preferred” pharmacy Medicare drug plans. In the interim hopefully more aggressive oversight by CMS, such as this disclaimer requirement, will help mitigate the patient confusion that community pharmacists encounter all too often.

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