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NACDS questions impact of restricted Rx networks

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WASHINGTON — The National Association of Chain Drug Stores says it is concerned about restricted pharmacy networks in the Affordable Care Act health insurance exchange plans.

“Preferred networks in the pharmacy sector may interfere with patient access to quality care,” NACDS told members of the House Oversight and Government Reform Committee last month. “The use of preferred networks limits patient access to pharmacy providers whose services improve lives and help address poor medication adherence, an issue that costs the nation approximately $290 billion annually.”

Emphasizing the importance of patient choice, the association noted that 92% of Americans live within five miles of a community retail pharmacy. Open networks provide greater access and choice, especially in more rural areas with fewer pharmacies, NACDS commented for a committee hearing on “Premiums, Provider Networks and the Health Care Law.”

“Community pharmacies meet patients’ needs for convenient access through a highly competitive environment that gives consumers choices in how their medications and health care services are provided,” NACDS said.

It added that plan limitations on the number of pharmacies that can participate in a network also limit patient access to knowledgeable professionals who play a critical role in providing care and cost savings.

“People who take prescription medications regularly, manage chronic diseases, use emerging pharmacy services, and who are older have even stronger positive opinions about access to a pharmacy of their choice,” NACDS said.

In addition, the association expressed misgivings about restrictions on drug formularies in exchange plans. The plans are apparently using the same restricted formularies for insurance products sold across all tiers, and the average co-insurance for a top formulary tier drug in a silver or bronze plan looks to be 40%. Moreover there are evidently formulary gaps for certain high-cost drugs.

“NACDS is concerned that patients who face restricted drug formularies and cost sharing may choose to skip their necessary medications, because they simply cannot afford the out-of-pocket costs,” the association said. “Overall care for these patients may prove more costly in the long run, defeating the goals of providing high-quality, more affordable care.”

Adheris Health

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