May 12, 2015

The Pharmaceutical Care Management Association (PCMA) today released a new ad campaign – “We Love our Preferred Pharmacy Plan” – highlighting the popularity and convenience of lower cost preferred pharmacy plans in Medicare.

“Lower cost preferred pharmacy plans have become the very foundation of Medicare Part D,” said PCMA President and CEO Mark Merritt. “It makes little sense for lawmakers to put these plans at risk.”

View the new ad.

The drugstore lobby has designed so-called “any willing pharmacy” legislation that would prohibit plans from creating preferred networks of pharmacies that offer better rates than their competitors. The legislation (H.R. 793/S. 1190) would undermine the availability of lower cost, preferred pharmacies and increase Medicare spending by $21 billion over the next 10 years, according to research from The Moran Company examining the same legislation introduced last year.

The bill targets markets that are “medically underserved” by physicians and hospitals – not pharmacies – and would impact 95% of all Medicare beneficiaries. The Moran study points out “there is not necessarily a relationship between the underserved areas targeted in the legislation and pharmacy access. The targeted underserved areas are identified by primary medical care, dental or mental health providers, without regard to pharmacy access.”

CMS ultimately excluded a similar “controversial” provision from its 2016 Final Part C & D Rule once Congress discovered that it would have put millions of seniors at risk of losing their Part D plans.

Research and polling highlight the value of preferred pharmacies in Medicare, including:

  • A survey of seniors in preferred pharmacy plans shows that nine out of 10 seniors from urban, suburban, small town and rural areas have convenient access to these preferred pharmacies in Part D.
  • An analysis of CMS Part D 2015 enrollment data by Drug Channels shows that 81 percent of seniors chose lower-cost preferred pharmacy plans that offer convenient access and extra discounts at certain pharmacies.
  • Last year, the FTC wrote a letter to CMS on “any willing pharmacy” provisions included in the agency’s proposed Medicare Part D rule and warned that: “The proposed any willing pharmacy provisions threaten the effectiveness of selective contracting with pharmacies as a tool for lowering costs. Requiring prescription drug plans to contract with any willing pharmacy would reduce the ability of plans to obtain price discounts based on the prospect of increased patient volume and thus impair the ability of prescription drug plans to negotiate the best prices with pharmacies.”
  • An actuarial study from Milliman finds that preferred pharmacies will reduce federal Medicare Part D costs up to $9.3 billion during the next 10 years.
  • CMS data and a study from Visante finds that access to preferred pharmacies in rural areas greatly exceeds Medicare’s access standards.

Currently, most national Part D pharmacy networks include nearly all drugstores — almost 67,000 nationwide — giving beneficiaries access to more pharmacy locations than the combined number of McDonald’s, Burger Kings, Pizza Huts, Wendy’s, Taco Bells, Kentucky Fried Chickens, Domino’s Pizzas, and Dunkin’ Donuts across the country.