The National Community Pharmacists Association claims that many Medicare Part D prescription drug plans (PDPs) aren't what they seem to consumers.


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NCPA: Preferred pharmacy Part D plans are restrictive

November 22nd, 2011

ALEXANDRIA, Va. – The National Community Pharmacists Association claims that many Medicare Part D prescription drug plans (PDPs) aren't what they seem to consumers.

Citing some Part D plans with large chain drug retailers as preferred pharmacy providers, NCPA said Monday that such coverage offers consumers a "restricted network" that limits them to a small number of pharmacies. What's more, the association said such plans are "deceptively marketed to patients" and may provide inadequate pharmacy access for rural Americans.

According to NCPA, the Humana Walmart-Preferred Rx Plan launched in October 2010 introduced restricted network pharmacy plans to Medicare Part D.

Similar plans were rolled out last month, including the Aetna CVS/pharmacy PDP and the First Health Value Plus PDP — a plan from Coventry Health Care with Walgreens, Walmart and Target as preferred pharmacy providers — as well as Rite Aid EnvisionRx Plus, which NCPA said brings the total number of such plans to six. The other plans include AARP Medicare Rx Preferred and CVS Caremark Plus.

NCPA said it has raised with Medicare officials two key problems with such PDPs. First, they are being marketed to patients and featured on Medicare's Plan Finder without making clear that the lowest advertised drug prices are only available at selected pharmacies, the association explained. Second, the plans' restricted networks may discriminate against patients in rural communities and conflict with Medicare pharmacy access requirements, NCPA said, noting that nearly all of these plans are centered on national pharmacy chains catering to large cities and suburban areas.

"From day one, these overly restrictive drug plans have raised questions about ensuring adequate access to pharmacy care, which is why NCPA has opposed them," NCPA chief executive officer B. Douglas Hoey said in a statement. "We urge Medicare officials to consider these marketing and patient access concerns and take action in the interest of seniors."

NCPA said that it recently sent a letter to the Centers for Medicare & Medicaid Services (CMS) urging the agency to modify the Medicare Plan Finder tool so it makes clear that lower-cost prescription drug cost sharing is only available at the preferred pharmacy. The letter also calls on CMS to require restricted network plans to openly and transparently state in all communications that patients must go to the preferred pharmacy to get the advertised drug costs.

"The cornerstone of the Part D program is improving senior access to pharmacy benefits and improving the quality of those benefits. However, NCPA is specifically concerned about the movement, over time, toward more Part D preferred network plans," the letter stated. "We do not believe that the MMA [Medicare Modernization Act] authorizes the establishment of such preferred networks. This movement towards more restrictive networks poses serious questions in terms of the quality of care patients receive, possible marketing violations, pharmacy network adequacy issues and complex benefit design issues."

The open enrollment period for Medicare Part D prescription drug benefits, which began earlier this year, on Oct. 15, runs through Dec. 7.

"We encourage every Medicare beneficiary to talk to a community pharmacist about choosing the right Medicare drug plan," Hoey added. "Pharmacists can be a tremendous resource to Medicare patients by educating them about the enrollment process and helping them 'plug in their drugs' using Medicare's Plan Finder tool at www.Medicare.gov. Only then can seniors, and their caregivers, rest assured that they are enrolled in the plan that best meets their individual health needs."

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