Expanding Access to Pharmacies in Part D

Expanding Access to Pharmacies in Part D

For decades, it seems, politicians have been talking about removing obstacles to health-care access, whether those obstacles are financial or physical. A new, bipartisan proposal would address both fronts in the area of Medicare drug plans.

For seniors, the advent of Medicare prescription-drug plans (or "Part D") has facilitated insurance coverage for prescription drugs and allowed patients broad pharmacy choice. However, in recent years, access has changed for the worse. Insurance middlemen -- that is, third-party benefit managers -- are requiring many patients to either pay higher out-of-pocket costs to continue using their pharmacy of choice or travel 20 miles or more to reach a pharmacy that offers discounted or "preferred" copays through the plan. The purpose of this inconvenience is often to encourage the use of mail order; not coincidentally, the largest pharmacy benefit managers also own mail-order pharmacies.

The agency that oversees Medicare -- the Centers for Medicare and Medicaid Services (CMS) -- sought to address this issue earlier this year by proposing to allow "any willing pharmacy" to offer patients "preferred" copays through a Part D plan, provided the pharmacy accepts the plan's contractual terms and conditions. However, Medicare put this regulation on hold, primarily because of concerns about unrelated items.

In response, Representatives Morgan Griffith (R., Va.) and Peter Welch (D., Vt.) introduced a targeted legislative remedy: H.R. 4577, the Ensuring Seniors Access to Local Pharmacies Act. This bill, much like the regulation, would allow community pharmacies located in medically underserved areas to participate as "preferred" pharmacies in any Part D plan, so long as they are willing to accept the plan's contract. Thus it would give beneficiaries greater choice and access to pharmacies closer to home while allowing them to enjoy the cost savings enjoyed by others. Part D patients in rural areas would especially gain from this bill, because they rely heavily on independent community pharmacies, which are typically blocked from participating as "preferred" pharmacies.

Expanding patient choice in this way has broad support. Three out of four likely voters (76 percent) said they backed H.R. 4577 in a national survey by Penn Schoen Berland, even after hearing the arguments of the insurance middlemen who oppose the bill. Voter support in the poll was strong among Republicans, Democrats, and independents alike. Key consumer- and health-advocacy organizations such as the National Grange, the National Rural Health Association, the Medicare Rights Center, the National Senior Citizens Law Center, the Consumers Union, and HealthHIV have endorsed the bill -- which also has 60 congressional cosponsors.

This is a necessary step in expanding pharmacy access. Ensuring seniors have proper access to medications and pharmacy providers helps to promote medication adherence, which in turn prevents costlier health treatments such as unnecessary visits to the emergency room and extended hospitalizations.

Moreover, after carefully reviewing the growing number of "preferred pharmacy" drug plans, federal Medicare officials concluded that an "any willing pharmacy" policy is "the best way to encourage price competition and lower costs in the Part D program." Consistent with that analysis, health-care economist and antitrust expert David Eisenstadt explained recently how H.R. 4577 has the potential to reduce Medicare costs: It would eliminate the exclusive arrangements between insurance middlemen and certain pharmacy chains that could be propping up drug costs by limiting competition.

Congress should act without delay to pass H.R. 4577. We encourage voters, Medicare beneficiaries, caregivers, and the entire health-care community to voice support for this measure so seniors in underserved communities have access to high-quality and cost-competitive health-care solutions.

B. Douglas Hoey is CEO of the National Community Pharmacists Association.

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