In the wake of an unfavorable decision by the Centers for Medicare and Medicaid Services (CMS), the National Community Pharmacists Association has stepped up its legislative campaign against restrictions on preferred pharmacy networks.

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NCPA ups ante in fight against preferred networks

March 14th, 2014

ALEXANDRIA, Va. – In the wake of an unfavorable decision by the Centers for Medicare and Medicaid Services (CMS), the National Community Pharmacists Association has stepped up its legislative campaign against restrictions on preferred pharmacy networks.

NCPA said Thursday that it has written to every U.S. senator and representative to ask their support for wider choice of pharmacy for seniors in Medicare drug plans, following CMS' move this week to postpone implementation of the patient choice provisions of a proposed rule for 2015 Medicare Part D drug plans.

In a letter to Capitol Hill, NCPA chief executive officer B. Douglas Hoey said community pharmacists are "deeply disappointed" in CMS' decision not to address issues with preferred pharmacy drug plans.

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

"By allowing independent community pharmacies to continue to be excluded from negotiations for preferred pharmacy arrangements in this taxpayer-funded program, some seniors are forced to travel 20 miles or more to reach a preferred pharmacy or pay a heftier copay at a non-preferred pharmacy," Hoey wrote. "We believe this is simply not right, and NCPA and our members will continue to fight for the patients they have been serving for decades."

He noted that there has been broad support for ensuring that the “any willing pharmacy” standard applies to preferred pharmacy networks.

"In fact, the statute explicitly states that a prescription drug plan must permit the participation of 'any willing pharmacy' that meets the terms and conditions of that plan," he explained. "It seems that the only opposition to opening preferred networks has come from those who profit immensely from its current structure of zero accountability to beneficiaries and taxpayers. CMS itself acknowledged that preferred pharmacy plans often raise costs to Medicare and the taxpayer, a clear violation of the Social Security Act, which Congress and CMS have a legal obligation to uphold."

He called on lawmakers to "introduce and co-sponsor pro-patient, pro-pharmacy legislation"  to address "this unfortunate misuse and abuse of the current law."

In addition, Hoey asked lawmakers to support other pro-patient, pro-pharmacy provisions of Medicare’s proposed rule, and wrote that NCPA will reiterate its support for these policies to CMS.

Those items include expanding medication therapy management (MTM) eligibility; requiring regular generic pricing updates; not penalizing seniors with higher co-pays for choosing their local community pharmacy over mail order; allowing CMS to combat fraud, waste, and abuse by requiring 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 tocomplaints to CMS.

NCPA said that members of Congress who have voiced their support for the "any willing pharmacy" proposal include Reps. Robert Aderholt (R., Ala.), Spencer Bachus (R., Ala.), Lou Barletta (R., Pa.), Earl Blumenauer (D., Ore.), Bradley Byrne (R., Ala.), Shelley Moore Capito (R., W.Va.), Kathy Castor (D., Fla.), Doug Collins (R., Ga.), Kevin Cramer (R., N.D.), Sam Farr (D., Calif.), House Judiciary Committee Chair Bob Goodlatte (R., Va.), Trey Gowdy (R., S.C.), House Small Business Committee Chair Sam Graves (R., Mo.), Morgan Griffith (R., Va.), Gene Green (D., Texas), Ruben Hinojosa (D., Texas), Walter Jones (R., N.C.), Peter King (R., N.Y.), Dan Lipinski (D., Ill.), Dave Loebsack (D., Iowa), Dan Maffei (D., N.Y.), Thomas Massie (R., Ky.), Bill Owens (D., N.Y.), Collin Peterson (D., Minn.), Phil Roe (R., Tenn.), Mike Rogers (R., Ala.), Tim Ryan (D., Ohio), John Sarbanes (D., Md.), Terri Sewell (D., Ala.), House Energy and Commerce Committee Ranking Member Henry Waxman (D., Calif.), Peter Welch (D., Vt.), and Lynn Westmoreland (R., Ga.).