Inside This Issue - News
Pharmacy groups weigh in on proposed Medicare Part D rule
March 17th, 2014
WASHINGTON – Several provisions in the Centers for Medicare and Medicaid Services’ proposed 2015 regulations for Medicare Part D prescription drug plans are being supported by the National Association of Chain Drug Stores and other retail pharmacy groups — particularly the CMS plan that would eliminate the preferred pharmacy network structure in favor of a preferred cost-sharing format.
Such a change, wrote NACDS senior vice president of government affairs and policy Carol Kelly in formal comments to CMS, “should allow beneficiaries to access pharmacy services in the manner and location that works best for them while achieving greater cost savings for CMS.”
Other provisions backed by NACDS include CMS’ Medicare Part D plan to expand eligibility for medication therapy management and its proposal for implementing standards related to prescription drug pricing — including those for regular price updating.
But other proposed changes to the prescription drug program under Part D would have a negative affect on medication access and affordability, charge critics. Some of those opponents elaborated on their concerns earlier this month at a teleconference sponsored by the Healthcare Leadership Council (HLC), whose members include pharmacies and health care product distributors.
The HLC, led by president Mary Grealy, has initiated a letter signed by about 275 organizations urging CMS to withdraw some of the proposed regulations, which it charges “would significantly reduce beneficiaries’ choice of plans and medicines and lead to disruptions in care.”
Among those addressing the HLC teleconference was Rep. Marsha Blackburn (R.,Tenn.). She stressed that an overwhelming percentage of senior citizens have expressed satisfaction with their Medicare plan and are apprehensive that the changes, if implemented, would hamper their access to needed medications and result in higher costs for those drugs that they still would receive.
Also addressing the teleconference was Andrew Sperling, director of federal legislative advocacy for the National Alliance on Mental Illness. He discussed how a proposed rule would allow insurers to deny access to some medications — including antidepressants. “The proposal undermines a key protection for some of the sickest, most vulnerable Medicare beneficiaries,” said Sperling.
He argued that a Medicare drug plan could have a list of preferred drugs with just two medications to treat schizophrenia, a scenario he described as inadequate because antipsychotic drugs work in different ways in the body and have different side effects.
In its proposal, which was published in the Federal Register, CMS called for removing “protected status” from antidepressants, antipsychotics and immunosuppressant medications.
The agency is of the opinion that the status designation, which the three classes have held since the 2006 launch of the Medicare prescription benefit, is no longer needed because of the expanded availability of generics.
HLC’s Grealy maintains that the CMS proposal is “a flawed solution” to a nonexistent problem. “The Medicare Part D program, as it stands, is an irrefutable success story — it has the approval of 90% of seniors; average monthly premiums have remained at steady, affordable levels; and the cost to taxpayers over the past decade has been more than 40% below original Congressional Budget Office projections.”
At a congressional hearing on the issue last month, Rep. Joseph Pitts (R., Pa.) said that Part D should serve as the model for future reforms to Medicare. “Instead, CMS proposes to dismantle the very features of the program that have made it so popular and successful,” he reflected.
In contrast to the positive reaction from NACDS and the National Community Pharmacists Association to abolish preferred pharmacy networks, Pitts pointed to a 2013 Milliman study that showed that preferred pharmacy structures will save taxpayers as much as $9.3 billion over the next 10 years.
But NCPA and other organizations counter that CMS was originally misled into believing that costs through preferred pharmacy networks would be uniformly lower and that the agency’s own study demonstrated otherwise.
“Community pharmacists support the pro-patient provisions of Medicare’s proposed rule because they offer more choice and pharmacy competition,” commented NCPA chief executive officer B. Douglas Hoey.