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ALEXANDRIA, Va. — Seniors would have more convenient access to discounted or “preferred” copays for prescription drugs at their pharmacy of choice under legislation reintroduced Thursday by Reps. Peter Welch (D, Vt.) and Morgan Griffith (R, Va.). The bipartisan legislation is endorsed by the National Community Pharmacists Association.
NCPA chief executive officer B. Douglas Hoey said: “Pharmacy benefit manager ‘preferred network’ policies often limit Medicare patients’ access to needed prescription drugs and the expert counseling provided by independent community pharmacies. But patients should be able to use the pharmacy of their choice if the pharmacy is willing to accept the drug plan’s contract terms and conditions. Allowing ‘any willing pharmacy’ to participate in Medicare drug plan preferred networks and ensuring reasonable reimbursement are vital components to changing the pharmacy payment model to a system that better serves patients. We applaud Reps. Welch and Griffith for the Ensuring Seniors Access to Local Pharmacies Act and their work to increase choice for patients and transparency into PBM tactics.”
The Ensuring Seniors Access to Local Pharmacies Act (H.R. 4946) would allow seniors in medically underserved areas to access lower copays at any pharmacy willing to accept the Medicare Part D drug plan’s “preferred pharmacy” terms and conditions (i.e., pricing). Currently, insurance middlemen known as pharmacy benefit managers are effectively telling many Medicare beneficiaries which pharmacy to use based on exclusionary arrangements between PBMs and, for the most part, Big Box pharmacies. Independent community pharmacies are often left out of such arrangements, despite playing a large role in caring for medically underserved populations. The result is that seniors in rural communities often face either higher copays or trips of 20 miles or more to a “preferred” pharmacy — likely passing many excluded community pharmacies along the way.
In addition to allowing “any willing pharmacy” located in medically underserved areas to participate in Medicare Part D drug plans’ discounted or “preferred” networks, the Ensuring Seniors Access to Local Pharmacies Act would require claims level reimbursement transparency so pharmacies have a clearer understanding of their reimbursement. This provision can be found in the Phair Pricing Act (H.R. 1034), which is also supported by NCPA and Reps. Welch and Griffith. Additionally, the Ensuring Seniors Access to Local Pharmacies Act includes language to prevent PBMs from reimbursing their affiliated pharmacies more than they do other pharmacies and to ensure reimbursement covers acquisition and dispensing costs, helping to establish a level playing field among all pharmacies.
Original cosponsors of the Ensuring Seniors Access to Local Pharmacies Act include Reps. Dave Loebsack (D, Iowa), Buddy Carter (R, Ga.), Vicente Gonzalez (D, Texas), Cathy McMorris Rodgers (R, Wash.), Cindy Axne (D, Iowa), Rick Allen (R, Ga.), Collin Peterson (D, Minn.), Rick Crawford (R, Ark.), Phil Roe (R, Tenn.), and Bruce Westerman (R, Ark.).
