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NCPA gives take on CMS final rule for Medicare Part D
May 21st, 2014
ALEXANDRIA, Va. – The Centers for Medicare & Medicaid Services (CMS) issuance this week of its final regulations for 2015 Medicare Part D prescription drug plans drew feedback from the National Community Pharmacists Association.
NCPA said Tuesday that it's still reviewing the final CMS rule but had some initial observations.
In announcing the release of the rules for 2015 Medicare Advantage and Part D plans, CMS said key provisions include requiring Part D prescribers to enroll in Medicare, revoking Medicare enrollment for abusive prescribing practices and patterns, expanded prevention and health improvement incentives, broadening the release of privacy-protected Part D data, improving payment accuracy and increased price transparency for network pharmacies.
"We commend CMS for requiring plan sponsors to both disclose to pharmacies the maximum allowable cost (MAC) reimbursement limits for many generic drugs and to update MAC-based reimbursement every seven days to better reflect market costs," NCPA chief executive officer B. Douglas Hoey said in a statement. "MAC is the black box of pharmacy reimbursement. Currently, community pharmacies are forced to sign take-it-or-leave-it contracts with giant pharmacy benefit managers (PBMs) without knowing their reimbursement rates for most drugs dispensed. Moreover, the cost of scores of generics is skyrocketing 1,000% or more virtually overnight, but the PBMs may wait months before updating reimbursement. That leaves community pharmacies with unsustainable losses of $60 to $100 or more per prescription."
Although that provision won't go into effect before the 2016 plan year, it will provide pharmacists with critical information about how they will be reimbursed for generic drugs, NCPA noted.
"CMS heard the concerns of many community pharmacies and rejected the misleading arguments made by those opposing this portion of the rule," Hoey said. "NCPA has worked for years to alert Medicare, Congress and state legislators about these problems. Twelve states have enacted MAC laws to date."
In its initial proposed regulation for 2015 Part D plans, CMS included a provision that would have broadened participation in preferred pharmacy networks. But in March that provision was among several measures dropped by the agency.
"Although CMS is not moving forward at this time to give seniors more pharmacy choice and open up exclusionary preferred pharmacy networks to more competition, NCPA appreciates the agency's comments in support of an 'any willing pharmacy' policy for PDPs," Hoey commented. "NCPA encourages CMS to continue to closely scrutinize these arrangements, including whether they may be discriminatory against certain beneficiaries.
NCPA added that in light of CMS' current position, Congress should enact the Ensuring Seniors Access to Local Pharmacies Act (H.R. 4577), a bipartisan bill that would give seniors more choice and easier access to discounted, or preferred, co-payments by allowing community pharmacies located in medically underserved areas to participate in all Part D drug plan networks.
"NCPA will continue to work constructively with CMS and members of Congress on both sides of the aisle on these and other pro-patient, pro-pharmacist issues," Hoey added.