As published in Modern Healthcare
By B. Douglas Hoey, RPh, MBA
CEO of the National Community Pharmacists Association
Earlier this year, Medicare proposed a rule that will foster more robust competition among pharmacies, increase rural access and give seniors more convenient interactions with trained health professionals.
At issue are favorable deals between pharmacy benefit managers (PBMs) and Big Box pharmacies. Medicare data show that these exclusive arrangements often RAISE Medicare costs while boosting these entities’ profits. So it is no surprise these multi-billion dollar companies are seeking to derail the rule’s implementation.
Currently, community pharmacies are routinely being denied the opportunity to participate in "preferred pharmacy" Medicare drug plan networks. Instead local pharmacies are often contractually obligated to charge higher co-pays than "preferred" pharmacies. As a result many seniors are steered toward those pharmacies arbitrarily chosen by their drug plan. By letting any pharmacy willing to accept a drug plan's "preferred pharmacy" terms and conditions participate Medicare will increase access for patients.
This will particularly benefit seniors in underserved rural areas that often are served only by small independent pharmacies. After studying data illustrating how the "preferred pharmacy" experiment was actually playing out, Medicare officials concluded that letting more providers participate as "preferred pharmacies" is the best way to encourage price competition and lower Part D costs.
This particular provision is supported by consumer advocates including the Medicare Rights Center, the National Committee to Preserve Social Security and Medicare, and the National Council on Aging.
Because many seniors prefer to talk to a pharmacist face to face Medicare's proposal will let more seniors choose between community pharmacies and mail order operations without penalty. In addition, the proposal will give more patients access to cost-saving medication therapy management consultations with pharmacists—something currently not offered to them.
Opposition to the overall proposed rule is coalescing around concerns about whether certain "protected class" drugs will no longer be covered and whether the number of prescription drug plans will be too limited. The National Community Pharmacists Association understands and appreciates these concerns. However, they are unrelated to and must be considered separately from the "any willing pharmacy" and medication therapy management provisions.
The community pharmacy provisions of the rule are estimated to have no Medicare cost impact. We encourage policymakers to to support competition, improved access and Medicare savings by implementing these pro-patient, pro-pharmacist provisions.