Bring real consumer choice back to Medicare Part D
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According to the Kaiser Family Foundation, the Medicare Part D program has approximately 41 million beneficiaries and 746 prescription drug plans. During the open enrollment period seniors use the Medicare Plan Finder to determine which option best fits their needs. The amount of information can make your eyes glaze over. Add to this, Medicare Part D ‘preferred pharmacy’ plans, which advertise attractive “savings” for seniors. But there is a catch.

These plans were first introduced to the public by Walmart and Humana in 2010. Beneficiaries receive discounted copays for purchasing prescription drugs from designated in-network retail or mail order pharmacies. They have proliferated with more offerings each succeeding year.

Unfortunately, many beneficiaries are lured into the plans by promised “savings,” only to receive an unwelcome surprise once they start using these plans: they learn that their favored local pharmacy is not in the preferred network.

America has approximately 22,000 independent community pharmacies, many in underserved areas that tend to lack the ‘preferred pharmacy’ tag because they don’t have the influence with the PBMs and plan sponsors that tend to create these plans. As a result, seniors in most instances pay higher copays if they choose to continue getting their prescription drugs from their longtime neighborhood pharmacy.

Here’s why it matters: A study commissioned by the National Community Pharmacists Association (NCPA), found that "patients' personal connection with a pharmacist or pharmacy staff is the top predictor of medication adherence." That’s important because according to the Network for Excellence in Health Innovation (NEHI), approximately $290 billion a year is wasted on improper medication use. In other words, we should facilitate, not hinder, the ability of patients to choose their pharmacy because it can ultimately lead to better health outcomes at a lower cost.

The fact is, preferred pharmacy networks can undermine that objective. For example, a Medicare study found more than half of the preferred pharmacy plans (54 percent) failed to meet the government's threshold for reasonable access to pharmacies in urban areas. In many rural areas, the closest ‘preferred pharmacy’ can be more than 20 miles away. That means many seniors or their caregivers not only have to travel long distances to the preferred plan’s designated pharmacy, but they’re also forced out of longstanding relationships with their neighborhood pharmacist. The alternative, especially for those on fixed-incomes who genuinely need the discounted copay, is mail order pharmacies, where the only patient-pharmacist interaction comes through a toll-free phone number.

Most often, the creators of preferred pharmacy networks are pharmacy benefit managers — the drug middlemen who also happen to own those mail order pharmacies they’re pushing patients to use. These plans do not mandate seniors use one pharmacy over another, but the financial incentive is often persuasive for seniors, especially those on fixed incomes.  

So what is the best way for promoting less spending on prescription drug copays, while encouraging greater medication adherence and consumer choice in Medicare’s preferred pharmacy plans? The answer is simple. Congress should pass the Ensuring Seniors Access to Local Pharmacies Act of 2017, which would allow pharmacies located in medically underserved areas to participate in Part D ‘preferred pharmacy’ networks, provided they accept the contract terms and conditions under which in-network providers operate.

The companion bills are generating bipartisan support, led by elected officials who have long championed this fix. The original sponsors for S. 1044 were Sens. Shelley Moore CapitoShelley Wellons Moore CapitoConway freezing out experts, relying on political staff in drug policy office: report Republican agenda clouded by division Fractured GOP struggles with immigration strategy MORE (R-W.Va.), Joe ManchinJoseph (Joe) ManchinMcConnell: 'Whoever gets to 60 wins' on immigration Manchin: Senators should sign pledge not to campaign against each other  GOP senators turning Trump immigration framework into legislation MORE (D-W.Va.), Tom CottonThomas (Tom) Bryant CottonThis week: Trump delivers State of the Union amid immigration fight Ingraham: White House yanked immigration plan defense from show After shutdown surrender, why should progressives ever trust Chuck Schumer again? MORE (R-Ark) and Sherrod BrownSherrod Campbell BrownTrump accuses Dems of 'treasonous' behavior Former Ohio football star faces conservative rival in GOP primary fight Dems press Trump for 'Buy American' proposals in infrastructure plan MORE (D-Ohio), while the original sponsors for H.R. 1939 were Reps. Morgan GriffithHoward (Morgan) Morgan GriffithRyan sets record for closing down debate in House: report It's time to eliminate the secretive Pharmacy Benefit Manager pricing practices GOP lawmaker: Mexico will pay 'part of the tab' for wall MORE (R-Va.) and Peter WelchPeter Francis WelchClinton mulls role in 2018 midterms Trump talks tough but little action seen on drug prices Frustrated with Trump, Dems introduce drug pricing bill MORE (D-Vt.).

By assuring a level playing field where more pharmacies can offer discounted copays and patients are free to choose their own pharmacy, the legislation would create more competition and not cost any more money to seniors or the taxpayers who fund Medicare.

Healthcare decisions should be made by patients, not by giant corporations looking to tilt the marketplace in their favor. Passing the Ensuring Seniors Access to Local Pharmacies Act of 2017 can fix this.

B. Douglas Hoey, RPh, MBA, is CEO of the National Community Pharmacists Association. Follow him on Twitter @RPhDouglas


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