Pharmacists: Bill Would Expand Seniors' Access to Lower Drug Copays

Allows More 'Preferred' Pharmacies in Underserved Areas

News provided by

National Community Pharmacists Association

Feb 09, 2015, 11:58 ET

ALEXANDRIA, Va., Feb. 9, 2015 /PRNewswire-USNewswire/ -- Seniors would have more convenient access to discounted or "preferred" copays for prescription drugs at their pharmacy of choice under new bipartisan legislation introduced recently and endorsed today by the National Community Pharmacists Association (NCPA).

Reps. Morgan Griffith (R-Va.) and Peter Welch (D-Vt.) have introduced H.R. 793. The legislation would allow seniors in medically underserved areas to access lower copays at any pharmacy willing to accept the Medicare Part D drug plan's "preferred pharmacy" terms and conditions (i.e., pricing).

Currently, many Medicare beneficiaries are effectively told by insurance middlemen (pharmacy benefit managers or PBMs) which pharmacy to use based on exclusionary arrangements between PBMs and, for the most part, Big Box pharmacies. Patients must pay higher copays if their pharmacy is excluded, even if it has not been given the opportunity to participate and is willing to accept the plan's "preferred" pricing.

"This bipartisan legislation would help give Medicare beneficiaries easier access to their prescription drugs at lower copays, while infusing greater competition into the Part D program," said NCPA CEO B. Douglas Hoey, RPh, MBA. "We commend Representatives Griffith and Welch on their leadership and encourage their colleagues to cosponsor this common-sense proposal."

The proposal would particularly benefit patients in underserved urban and rural communities who rely on independent pharmacies. According to a Medicare study, in urban areas more than half of "preferred" pharmacy drug plans (54 percent) failed to meet the government's threshold for reasonable access to pharmacies. In rural America the closest "preferred" pharmacy can be 20 miles or more away.

Earlier this year the confusion beneficiaries and caregivers experienced due to pharmacy network restrictions by Part D plans was illustrated by the glitch-plagued Aetna/Coventry Medicare Part D drug plans. Medicare officials confirmed approximately 400,000 beneficiaries may have been affected because their chosen pharmacy was erroneously advertised as "in network" during the 2014 open enrollment period.

"Those who wish to deny seniors greater access to copay discounts will claim that H.R. 793 would spell the end of 'preferred pharmacy' drug plans and increase Medicare costs. They're wrong," Hoey added. "This legislation simply increases choice for patients and competition among pharmacies, which can ultimately lower Medicare costs."

Medicare officials, after conducting a study, concluded that they cannot assume that preferred networks are less expensive for the government because they identified instances where they were in fact costlier to the program. Moreover, a leading health care economist has demonstrated how allowing the participation of "any willing pharmacy" as a "preferred pharmacy" can actually lower Medicare costs by increasing competition.

The National Community Pharmacists Association (NCPA®) represents the interests of America's community pharmacists, including the owners of nearly 23,000 independent community pharmacies. Together they represent an $88.8 billion health care marketplace, dispense nearly 40% of all retail prescriptions, and employ more than 300,000 individuals, including over 62,000 pharmacists. To learn more go to www.ncpanet.org or read NCPA's blog, The Dose, at http://ncpanet.wordpress.com/.

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SOURCE National Community Pharmacists Association