A provision that would broaden participation in preferred pharmacy networks was among several measures dropped by the Centers for Medicare & Medicaid Services (CMS) in its proposed regulation for 2015 Medicare Part D prescription drug plans.

Centers for Medicare & Medicaid Services, CMS, preferred pharmacy networks, proposed regulation for 2015 Medicare Part D, Part D prescription drug plans, Marilyn Tavenner, National Community Pharmacists Association, NCPA, B. Douglas Hoey, Academy of Managed Care Pharmacy, AMCP, Edith Rosato

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CMS pulls key items from proposed Part D changes

March 10th, 2014

WASHINGTON – A provision that would broaden participation in preferred pharmacy networks was among several measures dropped by the Centers for Medicare & Medicaid Services (CMS) in its proposed regulation for 2015 Medicare Part D prescription drug plans.

In a letter to congressional lawmakers on Monday, CMS administrator Marilyn Tavenner said that during the proposal's comment period, the agency received "numerous concerns" from lawmakers and stakeholders about some of its elements.

"In particular, we heard concerns about the proposals to lift the protected class definition on three drug classes, to set standards on Medicare Part D plans' requirements to participate in preferred pharmacy networks, to reduce the number of Part D plans a sponsor may offer, and clarifications to the noninterference provisions," Tavenner wrote. "Given the complexities of these issues and stakeholder input, we do not plan to finalize these proposals at this time. We will engage in further stakeholder input before advancing some or all of the changes in these areas in future years."

CMS, in its proposed Part D changes announced earlier this year, had called for allowing any pharmacies to participate as preferred pharmacy providers as long as they are willing to accept the contract terms offered by a drug plan.

The National Community Pharmacists Association was among the groups that had initially hailed CMS' proposal on preferred pharmacies. But on Monday, NCPA gave a thumbs-down to the agency's decision not to pursue it.

"We are deeply disappointed in CMS' decision not to move forward at this time with the pharmacy choice provision included in its proposed rule. CMS has heard repeatedly from community pharmacists and patients regarding the inadequacies of 'preferred pharmacy' drug plans. They have been deceptively marketed and are confusing to patients," B. Douglas Hoey, chief executive officer of NCPA, said in a statement.

"In many rural communities, independent community pharmacies are the only pharmacy provider, and they are often excluded from preferred pharmacy arrangements — financially penalizing these seniors or forcing them to travel 20 miles or more to reach a preferred pharmacy. In addition, many underserved populations rely on the personalized service of independent pharmacies and going to a 'preferred' pharmacy is a burden," Hoey explained.

"Of course, concerns surrounding the 'any willing provider' issue are not going away," he stated. "CMS has a legal obligation to uphold the Social Security Act, and CMS itself acknowledged that preferred pharmacy plans often raise costs to Medicare and the taxpayer, which is a violation of that statute. We implore CMS to revisit this topic in the near future."

Other key provisions scrapped included proposals to end the protected status for antidepressant, immunosuppressant and antipsychotic drugs — meaning that Part D plans wouldn't be required to cover all of those medications — as well as to limit insurers to offering seniors two options: a basic plan and an advanced plan.

When announcing the Part D changes in January, CMS said the proposed rule would save $1.3 billion from 2015 to 2019 if finalized. However, critics of the proposal — including 20 Senate Finance Committee members — claimed the changes would result in higher costs and negatively impact seniors' Part D benefits choice and access.

CMS' move to shelve the provisions was welcomed by the Academy of Managed Care Pharmacy (AMCP).

"The academy applauds CMS for putting on hold its proposed restructuring of the Medicare Part D program, sparing millions of seniors unnecessary disruption, loss of choice and higher costs," stated AMCP CEO Edith Rosato. "AMCP, along with hundreds of other Part D stakeholder organizations, successfully argued that the proposed rule would fundamentally change one of our most successful health care programs in ways that would have serious, negative consequences for millions of seniors. AMCP opposed several dropped provisions in the proposed rule related to preferred networks and 'any willing providers.' "

In her letter, Tavenner said CMS plans to finalize proposals related to consumer protections (such as ensuring ccess to care during natural disasters), anti-fraud provisions (such as bolstering standards for prescribers of prescription drugs) and transparency (including widening the release of privacy-protected Part D data).

"We encourage CMS to move forward with other key provisions in the rule," NCPA's Hoey added, "including expanding medication therapy management (MTM) eligibility; giving more seniors the same co-pay, in certain instances, whether they use a community pharmacy or mail order; allowing CMS to require plan sponsors to hire independent auditors; banning reimbursement practices that penalize long-term care pharmacies for adopting cost-efficient dispensing practices; and protecting seniors by establishing fulfillment requirements for mail order pharmacies, in response to a litany of complaints. NCPA and its members will continue to work constructively with federal and state policymakers regarding these issues."

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