A group of independent and rural pharmacies has formed AccessRx America, a coalition to preserve pharmacy choice for seniors under the Medicare Part D program.

AccessRx America, Medicare Part D, preferred pharmacy networks, Part D drug benefit plans, any willing pharmacy, Centers for Medicaid & Medicare Services, CMS, proposed regulation for 2015 Part D plans, prescription drug plans, preferred pharmacy providers, Bob Carey, Anthony Sartoris, Doc's Drugs, community pharmacies

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Community pharmacy group targets preferred networks

March 3rd, 2014

WASHINGTON – A group of independent and rural pharmacies has formed AccessRx America, a coalition to preserve pharmacy choice for seniors under the Medicare Part D program.

Announced Monday, AccessRx America said it's concerned about the growth of preferred pharmacy networks in Part D drug benefit plans.

Currently under preferred pharmacy drug plans, most pharmacies can participate as network pharmacies to meet Medicare's geographic access requirements. Yet only a limited number of pharmacies — typically large chains — are designated as preferred and are authorized to offer the plan's lowest advertised co-pays.

AccessRx America stressed its support for the "any willing pharmacy" provision made late last month by the Centers for Medicaid & Medicare Services (CMS) in its proposed regulation for 2015 Part D plans. The rule would restore the original Medicare requirement for prescription drug plans to enable any community pharmacies to participate as preferred pharmacy providers if they are willing to accept the contract terms offered by a drug plan.

"The 'any willing pharmacy' mandate is and always has been the core and supreme requirement for any of Medicare Part D prescription drug plan. But it has withered as prescription drug plan managers and big-box and national chain pharmacies figured out how to skirt Medicare's rules, exclude these willing pharmacies and siphon more prescriptions, customers and Medicare dollars to bolster their profits and amass market share," Bob Carey, executive director of AccessRx, said in a statement. "AccessRx is a grassroots organization of local pharmacists and pharmacy owners who are rallying to restore the original intent of the Medicare prescription drug program."

Operators of independent pharmacies and small drug chains have said the rising number of preferred pharmacy plans has presented a challenge for seniors in rural areas, where independent or regional drug stores are often the closest pharmacy and the nearest preferred pharmacy may be 20 miles or more away.

AccessRx noted that the "any willing pharmacy" provision will level the playing field for the nation's more than 23,000 independent and other community pharmacies by reopening access to millions of senior customers "to the competitive Medicare pharmacy marketplace that Congress originally intended."

"This [current] process of systematic exclusion stifles competition and places the Medicare system at risk of being exploited by a few huge pharmacy plans and national pharmacy chains who then leverage their market share into higher prices charged to Medicare," stated Anthony Sartoris, president of Doc's Drugs, a small pharmacy chain in Illinois. He added that its counterproductive for Medicare to place Star Ratings on pharmacies for medication therapy management (MTM) while allowing preferred networks to exclude independent and other community pharmacies, many of which are know for promoting patient medication adherence.

According to AccessRx, government studies indicate that broadening the pool of preferred pharmacies in Part D plans will save Medicare about $589 million per year by 2019 while giving seniors greater access to prescription drug cost savings in all regions of the country.

"The bottom line for America's seniors is that the continuation of the status quo may well mean the end of small, local pharmacies, a more restrictive marketplace and higher costs for the Medicare program," Carey added. "Adoption of the CMS proposed rule will ensure greater access and cost savings for Medicare over the long term and the ongoing existence of our nation's community pharmacies."