March 19, 2014
Pharmacy Groups Disappointed Over CMS’ Part D Rule Pullback

Washington, D.C.—Pharmacy advocacy groups expressed bitter disappointment over the Centers for Medicare & Medicaid Services (CMS) decision to postpone implementation of key parts of a proposed regulation for Medicare Part D prescription drug plans.

In the face of opposition from members of Congress, as well as more than 370 organizations representing insurers, drug makers, health providers, and others, CMS Administrator Marilyn Tavenner wrote in a March 10 letter about the proposed rule, “Given the complexities of these issues and stakeholder input, we do not plan to finalize these proposals at this time. We will engage in further stakeholder input before advancing some or all of the changes in these areas in future years.”

Just 5 days before, eight pharmacy organizations, representing more than 100,000 pharmacists nationwide across a variety of practice settings, sent a letter to CMS, supporting the agency’s proposal to expand medication therapy management (MTM) for Part D and encouraging the agency to move forward with the plan for contract year 2015.

In response to the Obama Administration’s abrupt turnaround on the issue, National Community Pharmacists Association (NCPA) CEO B. Douglas Hoey, RPh, MBA, said his group was “deeply disappointed in CMS' decision not to move forward at this time with the pharmacy choice provision included in its proposed rule. CMS has heard repeatedly from community pharmacists and patients regarding the inadequacies of ‘preferred pharmacy’ drug plans. They have been deceptively marketed and are confusing to patients.

“In many rural communities, independent community pharmacies are the only pharmacy provider and they are often excluded from preferred pharmacy arrangements—financially penalizing these seniors or forcing them to travel 20 miles or more to reach a preferred pharmacy. In addition, many underserved populations rely on the personalized service of independent pharmacies and going to a 'preferred' pharmacy is a burden.”

Hoey warned, “concerns surrounding the 'any willing provider’ issue are not going away. CMS has a legal obligation to uphold the Social Security Act and CMS itself acknowledged that preferred pharmacy plans often raise costs to Medicare and the taxpayer, which is a violation of that statute. We implore CMS to revisit this topic in the near future.”

Another issue of special concern to the pharmacy groups was the proposal to expand MTM eligibility.

Their letter to CMS applauded the rule but urged that it be refined so that pharmacists could directly interact with beneficiaries when providing the services.

Organizations signing the letter applauding the proposed rule included the American Association of Colleges of Pharmacy (AACP); American Society of Consultant Pharmacists (ASCP); American Pharmacists Association (APhA); American Society of Health-System Pharmacists (ASHP); International Academy of Compounding Pharmacists (IACP); National Alliance of State Pharmacy Associations (NASPA); National Association of Chain Drug Stores (NACDS); and the National Community Pharmacists Association (NCPA).

“Medication-related problems have a significant detrimental impact on the U.S. health care system, and MTM services are a mechanism to improve both the quality and cost of medication-related outcomes and overall health care,” the letter stated, pointing to studies indicating that for every $1 the healthcare system spends on MTM services, $12 is potentially saved within the Medicare program.

U.S. Pharmacist Social Connect