December 11, 2014


A recent analysis finds that almost nine out of 10 Medicare Part D prescription drug plans offered in the 2015 open enrollment season feature lower co-pays at preferred independent, chain, and big box pharmacies. In addition, a recent survey conducted by Hart Research Associates shows that nine out of 10 seniors from urban, suburban, small town and rural areas have convenient access to these discounted pharmacies in Part D.

These findings come as stakeholders await a new Centers for Medicare and Medicaid Services (CMS) report on access to preferred pharmacies with lower cost-sharing in Part D. An earlier CMS report was used to justify some of the most controversial provisions (which were later withdrawn) in the agency’s Part D proposed rule.

After the Federal Trade Commission and numerous health policy experts asserted that the proposed rule would undermine preferred pharmacy options, CMS took a new approach and decided to examine how far seniors live from “preferred” drugstores that offer the best discounts in each plan’s pharmacy network. Some view the study as a pretext for new CMS guidance that would disqualify popular plans from being offered again in 2016.

“It would harm seniors and make little political or economic sense for CMS to re-visit the idea of using guidance to reduce access to the most popular, affordable options in Medicare Part D,” said Pharmaceutical Care Management Association (PCMA) President and CEO Mark Merritt.

Third-party research highlights the value of preferred pharmacy networks in Medicare, including:

An actuarial study finds that preferred pharmacy networks will reduce federal Medicare Part D costs up to $9.3 billion during the next 10 years.

An actuarial study finds that eliminating preferred pharmacy networks in Part D would increase premiums by approximately $63 annually for over 75 percent of Part D enrollees and raise overall program costs by an estimated $24 billion over the next 10 years.

Currently, most national Part D pharmacy networks include virtually all drugstores—some 64,000 nationwide—giving beneficiaries access to more pharmacy locations than the combined number of McDonalds, Burger Kings, Pizza Huts, Wendy’s, Taco Bells, Kentucky Fried Chickens, Domino’s Pizzas, and Dunkin’ Donuts across the country.