NCPA Asks Medicare to Avoid Mail Order Bias

Ensure Seniors Can Choose Their Pharmacy Based on the Facts

 
Alexandria, Va (Nov. 3, 2009) - The National Community Pharmacists Association’s (NCPA) contention that pharmacy benefit managers (PBMs) force Medicare beneficiaries into mail order, even against their will, has been acknowledged by the Centers for Medicare and Medicaid Services' (CMS) recent actions.

 
PBMs are not only the administrators of prescription drug plans, but typically own mail order pharmacies as well, meaning any switch benefits them financially. The Medicare Modernization Act of 2003, which created the Part D prescription drug plan, requires a level playing field between mail order and community pharmacies.

 
“In establishing Part D, Congress clearly stated that seniors’ choice in pharmacy should be protected and that Medicare officials should be impartial arbiters," said Bruce T. Roberts, RPh, NCPA executive vice president and CEO. "Already, PBMs are allowed to impose tiered co-payments and other inducements favoring mail order, yet seniors overwhelmingly stay with their community pharmacist. Now, complaints of mailorder coercion are mounting and seniors face the threat of losing their choice.”

 
Roberts added, “Research shows that improper medication use, including poor adherence and waste, costs America's health care system $290 billion a year. Community pharmacists can help maximize the benefits of medication therapy. Dividing patients from their pharmacy of choice would do the opposite."

 
Enough patients are complaining to Medicare about heavy-handed PBM tactics to prompt the agency to take action. On March 30, CMS issued the 2010 Call Letter for Medicare Advantage Plans, which on page 93 stated:

          "Beneficiary Notice for Transfer of Prescriptions to Mail-Order. Given previous

          beneficiary complaints that sponsors are transferring their prescriptions from network

          retail pharmacies to network mail-order pharmacies without their explicit consent, we

          will require sponsors to notify their affected enrollees prospectively of any such trans-

          ferred prescriptions. We intend to provide a new model notice for this purpose."

 
On October 30, NCPA sent a letter to CMS commenting on the draft model notice. NCPA commended the agency for trying to address the problem, but argued that its proposed notice could lead to pro-mail order advertisements, rather than the unbiased, factual information seniors deserve. From NCPA’s letter:

          "Of additional concern is leeway that is given plans in the letter to clearly tout the

           purported benefits of mail order. Instead of strictly stating the facts, such as you can

           purchase this medication through a mail order pharmacy at a reduced co pay, the plans

          will be free to tout their beliefs that mail order is more convenient, is a value-added

          service, saves money, etc.

          "In order to ensure a level playing field between retail community and mail order

           pharmacy, NCPA requests that the letter objectively describe to beneficiaries that

           options to obtain a 90-day supply of medication are available not only via mail order,

           but via retail community pharmacy as well. NCPA also requests that plans not be

           allowed to promote mail order beyond stating that it is an option for consideration.

           As CMS has clearly stated, this model letter is to inform beneficiaries of their rights,

           not to steer them toward mail order without due mention of options that are available

           at both mail and retail.

          "Additionally, NCPA is requesting that the notice must be provided in writing and not

           by verbal means only, in order to make sure plans do not aggressively implement

           programs that target beneficiaries to unknowingly agree to opt in to mail order delivery."

 

For a complete copy of the NCPA letter, go here.