The National Community Pharmacists Association is calling for a special enrollment period for Medicare Part D patients who claim deceptive marketing led them to sign up for a prescription drug plan with a restrictive "preferred pharmacy" network.

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NCPA: Medicare Part D patients 'duped' into preferred pharmacy networks

January 19th, 2012

ALEXANDRIA, Va. – The National Community Pharmacists Association is calling for a special enrollment period for Medicare Part D patients who claim deceptive marketing led them to sign up for a prescription drug plan with a restrictive "preferred pharmacy" network.

NCPA said Thursday that it has sent a letter to the Centers for Medicare & Medicaid Services (CMS) to spotlight complaints about "material misrepresentations" in Medicare drug plan information that caused patients to lose access to their pharmacy of choice because the low medication co-payments advertised were available only at drug stores in the preferred network, which in some cases were located far away.

In 2011, the Part D enrollment period began a bit earlier than in previous years, starting on Oct. 15 and lasting until Dec. 7. But since the start of 2012, NCPA explained, local pharmacists have heard repeated complaints from patients citing such misrepresentations through the Medicare Plan Finder (CMS' web portal), online plan advertising and Part D plan enrollment agents.

In the letter, NCPA urged CMS to take immediate action. "Given that these patients believe they have been subject to material misrepresentations in the marketing of their Part D plan, they should be allowed to take advantage of a special enrollment period and enroll in a different Part D plan that is more convenient for them," the letter stated. "We believe that this remedy is plainly applicable with regard to the beneficiary complaints that we are seeing."

The association attached to the letter a list of complaints that community pharmacists have fielded from patients. Complaints included the following:

• "A long-time customer of mine presented his new Humana Part D card and got his generic Rx filled for a $7 co-pay. He said it should be zero co‐pay. He said his agent sold him the plan based on zero co-pay for generics. He looked into it and the zero co-pay is only available at Walmart (he was not told this). Now he must go there, instead of the pharmacy of his choice for zero co‐pay generics."

• "I have had three different patients who signed up for First Health (Medco) Part D based on information given on the CMS site for plan search. These patients entered our pharmacy and the medication lists they are currently taking. The response was that they would have $0 copay on generics. The reality was when we filled their first prescriptions, their copays for generics were $7. When they called Medco, they were told those copays only applied at 'select preferred' pharmacies such as Walgreens, Walmart, Sam's and Costco. They feel this was very deceptive."

• "The website indicated that the First Health Part D Value Plus plan would be least expensive for 19 of my customers. It indicated they would have $0 copay for Tier 1 generics and $0 deductible. My pharmacy was indicated as a participating pharmacy; however, it was not evident that I was not a preferred pharmacy. These patients now have co‐pays and I risk losing all of the prescriptions for 19 customers. Located in a town of only 700 people, this is critical to my business. My customers are upset."

• "I had two patients ask if we were considered preferred on the Coventry network before they signed up on their Part D plan for 2012. After the plan began, we ran their insurance to find that we are part of the network, but the patient could only get their $0 copay at specific 'preferred' chains. The language used in the literature confused the patients and caused them to join a plan that put them at a disadvantage when shopping at our store. Now they are forced to fill their Rxs at another pharmacy to get the savings they were counting on when they joined this plan."

NCPA chief executive officer B. Douglas Hoey noted that the association previously warned that such Medicare Part D plans were overly restrictive, deceptively marketed to patients and lacked adequate pharmacy access for people in rural or underserved areas.

"It is unfortunate that our concerns were validated within the first few days of the 2012 plan year," Hoey said in a statement. "Now seniors are going to the community pharmacy that they have relied on for years, sometimes decades, only to be told that they must travel 20 miles or more to obtain the lowest-advertised co-payments for their medication."

He added that, "as a matter of fairness," CMS should give all enrollees in such prescription drug plans (PDPs) the chance to re-evaluate them. "Every day, about 10,000 Americans turn 65 and are eligible to enroll in a Medicare drug plan. Medicare should allow seniors who feel that they've been duped the same choice as those just entering the program," he stated. "In addition, CMS should implement preventative steps to avoid a repeat of this situation next year."

According to NCPA, the Humana Walmart-Preferred Rx Plan launched in October 2010 introduced restricted network pharmacy plans to Medicare Part D. Similar plans came out in October 2011, 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. Other plans include AARP Medicare Rx Preferred and CVS Caremark Plus.

NCPA is urging community pharmacists to encourage and assist patients in filling out a CMS complaint form, calling 1-800-MEDICARE or filing a complaint via the association's website.