The final Medicare rule addresses needed regulatory reform to any willing pharmacy standards, improving seniors’ access to the medications they need from the pharmacies they choose and addressing network contract requirements that have previously served to exclude and restrict pharmacy networks.
The rule recognizes that there is a role in the Part D program for pharmacy accreditation and that accreditation should promote quality rather than serve as a barrier to network participation. The rule also requires Part D plans to have lower maximum co-payments for biosimilar drugs for patients. Noticeably absent from the final rule are provisions that would apply some manufacturer rebates and all pharmacy price concessions to the price of the drug at the point of sale. Instead of addressing these issues, CMS has stated it will use ideas from stakeholders to evaluate and consider proposals for future rulemaking.
“NASP is pleased the administration is taking some initial steps to lower co-payments for seniors, and that CMS is focused on ensuring seniors can receive drugs at the pharmacy that they carefully choose together with their physician. NASP also applauds CMS for their focus on pharmacy accreditation, as NASP believes that independent, third party accreditation demonstrates a commitment to quality, safety, accountability and the adoption of nationally recognized standards of practice,” Sheila Arquette, NASP Executive Director said in a statement.
“However, there is still much more work to do to truly reduce costs to seniors and ensure specialty medication access. The administration should respond to bipartisan requests made by members of Congress to address DIR fees, which ultimately increase seniors’ out-of-pocket costs on the front-end and result in significant fees on the back-end that severely limit a specialty pharmacy’s ability to provide critical patient care support services – services that save Medicare expenditures by ensuring medication compliance and reducing avoidable emergency room visits and hospitalizations. This issue is bigger than Medicare drug costs. It’s about health system costs and reigning in costs to Medicare and taxpayers,” she said.
Arquette added the NASP looks forward to working with the administration and Congress on additional Part D reforms that address the needs of specialty pharmacy patients as the pharmaceutical distribution and pharmacy practice landscape continues to rapidly evolve.