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 CapitoTech CEOs clash with lawmakers in contentious hearing GOP power shift emerges with Trump, McConnell Bill to expand support for community addiction treatment passes House MORE (R-W.Va.), Joe ManchinJoseph (Joe) ManchinBitter fight over Barrett fuels calls to nix filibuster, expand court Democratic Senate emerges as possible hurdle for progressives  Susan Collins and the American legacy MORE (D-W.Va.), Tom CottonTom Bryant CottonCotton mocks NY Times over claim of nonpartisanship, promises to submit op-eds as test Barrett fight puts focus on abortion in 2020 election COVID outbreak threatens GOP's Supreme Court plans MORE (R-Ark) and Sherrod BrownSherrod Campbell BrownOn The Money: Dow falls more than 900 points amid fears of new COVID-19 restrictions | Democrats press Trump Org. about president's Chinese bank account | Boeing plans thousands of additional job cuts Democrats press Trump Organization about president's Chinese bank account Brown says Biden's first moves as president should be COVID relief, voting rights MORE (D-Ohio), while the original sponsors for H.R. 1939 were Reps. Morgan GriffithHoward (Morgan) Morgan GriffithMichigan Republican isolating after positive coronavirus test GOP Rep. Mike Bost tests positive for COVID-19 Democratic Rep. Carbajal tests positive for COVID-19 MORE (R-Va.) and Peter WelchPeter Francis WelchShakespeare Theatre Company goes virtual for 'Will on the Hill...or Won't They?' Vermont Rep. Peter Welch easily wins primary Vermont has a chance to show how bipartisanship can tackle systemic racism 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

The views expressed by contributors are their own and are not the views of The Hill.