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 CapitoSenate takes symbolic shot at Trump tariffs America must act to ensure qualified water workforce Overnight Health Care: Big win at Supreme Court for anti-abortion centers | HHS chief grilled on migrant children | Boom time for ObamaCare insurers? MORE (R-W.Va.), Joe ManchinJoseph (Joe) ManchinDoug Jones walks tightrope on Supreme Court nominee Red-state Dem tells Schumer to 'kiss my you know what' on Supreme Court vote Dem infighting erupts over Supreme Court pick MORE (D-W.Va.), Tom CottonThomas (Tom) Bryant CottonOvernight Defense: Fallout from tense NATO summit | Senators push to block ZTE deal in defense bill | Blackwater founder makes new pitch for mercenaries to run Afghan war Hillicon Valley: DOJ appeals AT&T-Time Warner ruling | FBI agent testifies in heated hearing | Uproar after FCC changes rules on consumer complaints | Broadcom makes bid for another US company | Facebook under fire over conspiracy sites Hillicon Valley: Justice Department appeals AT&T-Time Warner ruling | New report on election security | FBI agent testifies in marathon hearing MORE (R-Ark) and Sherrod BrownSherrod Campbell BrownSenate Dems tell Trump: Don't meet with Putin one-on-one On The Money — Sponsored by Prudential — Trump walks back criticism of UK Brexit strategy | McConnell worries US in 'early stages' of trade war | US trade deficit with China hits new record Blueprint to Lower Drug Prices could offer a way forward in fight against mushrooming costs MORE (D-Ohio), while the original sponsors for H.R. 1939 were Reps. Morgan GriffithHoward (Morgan) Morgan GriffithTommy Thompson: Here's how we can use better data to combat opioids Food stamp revamp sparks GOP fight over farm bill Lawmakers explore ways to reinstate House chaplain MORE (R-Va.) and Peter WelchPeter Francis WelchDems struggle with unity amid leadership tensions New Dem star to rattle DC establishment Overnight Defense: Defense spending bill amendments target hot-button issues | Space Force already facing hurdles | Senators voice 'deep' concerns at using military lawyers on immigration cases 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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