Any Willing Pharmacy

Medicare beneficiary access to prescription drugs is impeded by mandates from insurance middlemen (pharmacy benefit managers or PBMs) that effectively dictate which pharmacy to use based on exclusionary "preferred pharmacy" arrangements between PBMs and, often, Big Box or mail order pharmacies. Independent community pharmacies are not allowed to participate in some of these arrangements, even if they offer to accept the Part D plan's same contract terms and conditions.

This can raise access issues for patients in underserved and rural areas in which independent community pharmacies are predominantly located, which means seniors in these communities often face either higher copays or trips of 20 miles or more to a "preferred" pharmacy.

To address this, Reps. Peter Welch (D-Vt.) and Morgan Griffith (R-Va.) reintroduced the Ensuring Seniors Access to Local Pharmacies Act (H.R. 4946). This bipartisan legislation would allow pharmacies that are located in medically underserved areas, medically underserved populations, health professional shortage areas, or Federal Office of Rural Health Policy’s designated rural areas to participate in Medicare Part D preferred pharmacy networks so long as they are willing to accept the contract terms and conditions. For seniors in these communities, having their community’s sole pharmacy excluded from preferred networks creates unnecessary barriers to medication access.

Past iterations of the Ensuring Seniors Access to Local Pharmacies Act have been endorsed by leading national patient advocacy organizations, including The AIDS Institute; Alliance for Retired Americans; Center for Medicare Advocacy, Inc.; Families USA; HealthHIV; Justice in Aging; LeadingAge; Medicare Rights Center; National Consumers League; National Grange: National Rural Health Association; Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders (SAGE); and U.S. Pain Foundation.

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