Pharmacy Choice

Pharmacy Choice

Consumers

Background: Some health plans, particularly those in the Medicare Part D program, have selected certain national chain pharmacies to be the plan's "preferred" pharmacy. Whether they like it or not, patients in these plans must change pharmacies or pay higher co-pays to stick with their current pharmacy.

Independent community pharmacies are often excluded by, health plans from such arrangements.

Bipartisan legislation has been proposed to give many seniors greater choice of pharmacy. The Ensuring Seniors Access to Local Pharmacies Act (H.R. 4577), introduced by U.S. Reps. Morgan Griffith (R-Va.) and Peter Welch (D-Vt.), would allow community pharmacies located in a medically underserved area to participate in all Medicare Part D drug plan networks, including the plan's discounted or "preferred" network.

The opportunity for community pharmacies to participate in preferred plans which is sometimes referred to as "any willing pharmacy," would greatly benefit patients.

  • More choice of pharmacy - Increased competition gives consumers more options to choose a pharmacy based on customer service.

  • Help for rural, underserved areas - In less populated areas patients may have to travel 20+ miles to reach a "preferred" pharmacy, likely passing one or more excluded community pharmacies along the way. For example, in Florence, Ore. (population: 8,466) Medicare beneficiaries live within one mile of five different pharmacies, on average, but must travel more than 40 miles to reach a preferred pharmacy in either the Humana Enhanced or Humana Preferred Rx drug plan.

  • Diverse populations would benefit - Patients with special needs, including those for whom English is a second language, rely on the personalized care of community pharmacies that are often excluded from "preferred" status. For more, read these patient and pharmacy profiles.

  • Key consumer group support - H.R. 4577 has been endorsed by leading national patient advocacy organizations, including Consumers Union; HealthHIV, Medicare Rights Center, National Grange, National Rural Health Association, and the National Senior Citizens Law Center.

  • Medication adherence - As much as $290 billion in annual health care costs occur from improper medication use, or "non-adherence." The biggest predictor of medication adherence is patients' personal connection (or lack thereof) with a pharmacist or pharmacy staff and patients of independent community pharmacies reported the highest level of personal connection (89 percent agreeing that pharmacist or staff "knows you pretty well"), according to Medication Adherence in America: A National Report Card.

  • Greater competition and cost savings - Federal Medicare officials have concluded that the any willing pharmacy policy is "the best way to encourage price competition and lower costs in the Part D program." They identified many instances in which the sweetheart arrangements between drug plans and Big Box pharmacies were actually INCREASING costs. However, Congress must act because Medicare has refrained for now from implementing the pharmacy choice policy.

  • Take action - Contact your elected officials to ask them to support H.R. 4577, The Ensuring Seniors Access to Local Pharmacies Act. Go to www.fight4rx.org to make your voice heard.

  • Share your support for #pharmacychoice. Follow NCPA on social media: Twitter Facebook Google+YouTube

Government

Background: Some Medicare Part D prescription drug plans have selected certain national chain pharmacies to be the plan's "preferred" pharmacy. Whether they like it or not, patients in these plans must change pharmacies or pay higher co-pays to stick with their current pharmacy.

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 The Ensuring Seniors Access to Local Pharmacies Act (H.R. 4577). This bipartisan bill, introduced by U.S. Reps. Morgan Griffith (R-Va.) and Peter Welch (D-Vt.), would allow community pharmacies located in a medically underserved area to participate in all Medicare Part D drug plan networks, including the plan's discounted or "preferred" network.

Congress must enact H.R. 4577 because Medicare has refrained for now 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 and would greatly benefit patients. H.R. 4577 has garnered the support of:

  • 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.

  • 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 pharmacy to claim that Medicare Part D drug prices will increase, and the policy could even reduce the program’s cost under certain conditions, 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 and manipulate data 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.

H.R. 4577 cosponsors include:

Rep. Scott, Austin [R-Ga.) Rep. Loebsack, David [D-Iowa)
Rep. Cole, Tom [R-Okla.) Rep. Forbes, J. Randy [R-Va.)
Rep. Fortenberry, Jeff [R-Neb.) Rep. Tonko, Paul [D-N.Y.)
Rep. Hinojosa, Ruben [D-Tex.) Rep. Noem, Kristi L. [R-S.D.)
Rep. Goodlatte, Bob [R-Va.) Rep. Duncan, John J., Jr. [R-Tenn.)
Rep. Gallego, Pete P. [D-Tex) Rep. Southerland, Steve II [R-Fla.)
Rep. Sarbanes, John P. [D-Md.) Rep. Kelly, Mike [R-Penn.)
Rep. Ruppersberger, C. A. Dutch [D-Md.) Rep. Collins, Chris [R-N.Y.)
Rep. Capito, Shelley Moore [R-W.Va.) Rep. Rice, Tom [R-S.C.)
Rep. Crawford, Eric A. "Rick" [R-Ark.) Rep. Walz, Timothy J. [D-Minn.)
Rep. Lipinski, Daniel [D-Ill.) Rep. Scott, David [D-Ga.)
Rep. McAllister, Vance M. [R-La.) Rep. Wilson, Joe [R-S.C.)
Rep. Davis, Rodney [R-IL-13] Rep. Fleischmann, Charles J. "Chuck" [R-TN-3]
Rep. Slaughter, Louise McIntosh [D-NY-25] Rep. Ellmers, Renee L. [R-NC-2]
Rep. Deutch, Theodore E. [D-FL-21] Rep. Whitfield, Ed [R-KY-1]
Rep. Tierney, John F. [D-MA-6] Rep. Massie, Thomas [R-KY-4]
Rep. Ryan, Tim [D-OH-13] Rep. Bishop, Sanford D., Jr. [D-GA-2]
Rep. Jones, Walter B., Jr. [R-NC-3] Rep. Roe, David P. [R-TN-1]
Rep. Collins, Doug [R-GA-9] Rep. Braley, Bruce L. [D-IA-1]
Rep. Harper, Gregg [R-MS-3] Rep. Shuster, Bill [R-PA-9]
Rep. Cotton, Tom [R-AR-4]  

Pharmacists

Background: Congress must act to pass "any willing pharmacy" legislation to open up preferred pharmacy Medicare Part D drug plans to competition from independent community pharmacies.

Take action now! Here's what you need to do:

  1. 1. Make an appointment to speak to your federal representatives over a congressional recess when they are back home. Tell them you are disappointed that Medicare declined to act and ask them to co-sponsor H.R. 4577, The Ensuring Seniors Access to Local Pharmacies Act, to support you, your business, and your patients.

  2. 2. If your member of Congress is not home or you can't schedule a visit, contact them with the message in No. 1.

Check out the Preferred Pharmacy Toolkit for pharmacists at the NCPA Advocacy Center (look on the right-hand side of the page).

Share your support for #pharmacychoice. Follow NCPA on social media: Twitter Facebook Google+YouTube

ASK YOUR FAMILY PHARMACIST ™

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