Background: Some health plans, particularly Medicare prescription drug plans, have selected certain pharmacies to be the plan's "preferred" pharmacy. Many patients in these plans, whether they like it or not, must change pharmacies or pay higher copays to stick with their current pharmacy.
Independent community pharmacies are often excluded by health plans from such arrangements.
Patients should be able to access discounted copays at any pharmacy that is willing to accept the insurance plan's terms and conditions (i.e., pricing). This policy is sometimes referred to as "any willing provider."
Background: Some Medicare prescription drug plans have selected certain pharmacies to be the plan's "preferred" pharmacy. Many patients in these plans, whether they like it or not, must change pharmacies or pay higher co-pays to stick with their current pharmacy.
Some patients currently face onerous trips to access discounted copays at one of their Medicare drug plan's "preferred" pharmacies. Most of these drug plans fail to meet the government's convenient access standard in urban areas.
Independent community pharmacies are often excluded by health plans from such arrangements, even though these pharmacies are predominantly located in underserved areas. In fact, in some rural areas seniors may have to travel 20 miles or more to reach a "preferred" pharmacy, likely bypassing more convenient community pharmacies along the way.
Support Medicare "any willing provider" legislation. It would allow patients to use their pharmacy of choice, so long as it is willing to meet the drug plan's terms and conditions (i.e., pricing).
Congress must act because Medicare has refrained from implementing the pharmacy choice policy despite it already existing in current law.
Pharmacy choice or "any willing provider" in Medicare Part D has broad support
Members of Congress across the political aisle, including House Judiciary Committee Chair Bob Goodlatte (R-Va.) and; House Transportation & Infrastructure Chair Bill Shuster (R-Pa.); and House Rules Committee Ranking Member Louise Slaughter (D-N.Y.). (Full list of supportive lawmakers below).
Key consumer groups - including Consumers Union, HealthHIV, Medicare Rights Center, National Grange, National Rural Health Association, and the National Senior Citizens Law Center.
Voters—your constituents - Three-out-of-four likely voters (76%) support this policy, according to a national poll by Penn Schoen Berland. Support for the proposal is high among Republicans, Democrats and Independents alike.
PBM scare tactics and cost claims unfounded
Pharmacy benefit managers (PBMs) foisted "preferred pharmacy" networks and PBM-owned mail order on to the Centers for Medicare & Medicaid Services (CMS) with the promise of grandiose cost savings. In fact, five separate analyses over the past year of Medicare data have shown that preferred pharmacies and/or mail order are often more costly for the program.
There is "insufficient basis" for opponents of any willing provider to claim that Medicare drug prices will increase, and the policy could even reduce the program's cost, according to an independent economic analysis. The analysis was prepared by economist Dr. David Eisenstadt, veteran of the U.S. Department of Justice Antitrust Division and Principal at Microeconomic Consulting and Research Associates (MiCRA).
The large corporate giants that have profited mightily from the proliferation of preferred pharmacy networks to date are continuing to distort the facts to protect their market positions even in the face of data that these arrangements are potentially harmful to beneficiary health. For more evidence of this read this rebuttal which counters two PBM-financed white papers prepared by Milliman.
The PBMs' real motive is to protect their profits by fighting anything that could undermine the market share of PBM-owned mail order pharmacies. Because of poor mail order service—documented by Medicare officials on their website—PBM-owned mail order pharmacies fail to win over many patients voluntarily. PBMs mandate or incentivize mail order by imposing artificial barriers to patient choice—such as telling seniors they must travel 20 miles or more to reach a 'preferred' pharmacy unless they opt for mail.
Cosponsors of any willing provider legislation (H.R. 4577) in the just-concluded 113th Congress include the following. New legislation is expected to be introduced soon in the 114th Congress:
Download the chart above.
Background: While any willing provider receives broad based support from consumer organizations, a diverse bipartisan co-sponsorship list, and the public, Congress still needs to hear from pharmacists and patients.
Take action now!
- Make an appointment to speak to your federal representatives when they are back home. Tell them you are disappointed that Medicare declined to act and ask them to co-sponsor any willing provider legislation. Click here for tips on scheduling a meeting with your member of Congress.
- If your member of Congress is not home or you can't schedule a visit, make use of the grassroots toolkit on the left hand side of this page to make your voice heard.
Share your support for #pharmacychoice. Follow NCPA on social media:
NCPA has released two 60-second radio advertisements. Both can be utilized by community pharmacies as paid ads on their local radio stations, information for consumers calling the pharmacy, content for pharmacy websites or for other purposes.
The first ad, "George and Joan," depicts a married couple newly eligible for Medicare and upset to discover that their drug plan is forcing them to pay more for their medications or switch pharmacies. George reacts, "A bunch of darn bureaucrats. Joan, we're 67 years old and have been running our lives and paying taxes. Now, they tell us how to live." The ad concludes by noting, "It's time politicians know—greater access to medicine starts with more choices for you."
The second ad, "Rigged," summarizes how insurance middlemen effectively tell people where to get their prescription drugs by making it too expensive to go to another pharmacy of their choosing.
"Three huge corporations control about 70 percent of all prescription orders in our country—70 percent!" the announcer notes. "That's big money! And that blocks local community pharmacists from having a real shot at competing." She concludes, "Don't let bureaucrats and big money restrict your access to the medicine you need."
Web banner ads for online use
NCPA also developed banner ads for websites. The ads make the case for patient access to medication and pharmacy choice and can be hyperlinked to more information at NCPA's dedicated "any willing provider" Web page: www.ncpanet.org/pharmacychoice. Community pharmacies can feature them on their websites or sponsor them as advertisements on local online news outlets such as newspapers. The ads were produced in industry-standard sizes (300x250 and 728x90).