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Pharmacists Commend Congress' Concern Over Medicare Preferred Pharmacy Drug Plans

NCPA Questions Cost Savings of the Plans

ALEXANDRIA, Va., March 21, 2013 /PRNewswire-USNewswire/ --Thirty-one U.S. Representatives and a U.S. Senator have written to Medicare raising questions about the impact of so-called "preferred pharmacy" drug plans, which may actually raise costs to the Medicare Part D program and taxpayers, according to a recent statement by Medicare officials and an analysis by the National Community Pharmacists Association (NCPA).

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Preferred pharmacy plans differ from traditional drug benefit plans in that they establish tiers of pharmacies.  The plans allow most pharmacies to participate as "network" pharmacies in order to allow the plan to satisfy Medicare's geographic access requirements.  But only a limited number of pharmacies are allowed by the plan to participate as a "preferred" pharmacy authorized to offer the plan's lowest, advertised co-pays.  Most plans do not allow independently owned pharmacies to participate as a preferred pharmacy in their network.  The increasing number of preferred pharmacy plans are especially challenging for seniors in rural areas, where independent or regional pharmacies are often the closest pharmacy and where the nearest preferred pharmacy may be 20 miles or more away.

"We have been hearing increasing concern from Medicare beneficiaries and small business owners regarding Medicare Part D plans that feature preferred pharmacy networks," wrote U.S. Representatives H. Morgan Griffith (R-Va.), Peter Welch (D-Vt.) and 29 other Representatives, adding that "we fear these networks could lead to a decrease in access to quality care and threaten the survival of community pharmacies."

The lawmakers noted they were concerned over questions about the usefulness of the Medicare Plan Finder website and the fact that some plans may require seniors to travel long distances to reach a preferred pharmacy.  They asked the Acting Administrator of the U.S. Centers for Medicare & Medicaid Services (CMS) to "outline a plan to mitigate any hardship" that the plans may cause beneficiaries and community pharmacists, and asked if Medicare plans to "expand opportunities for independent pharmacies to join and compete with the Part D preferred networks on a level playing field."

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