Don’t ex­clude com­mu­nity phar­ma­cists

Modern Healthcare - - COMMENT - By B. Dou­glas Hoey B. Dou­glas Hoey is CEO of the Na­tional Com­mu­nity Phar­ma­cists As­so­ci­a­tion, Alexan­dria, Va.

Ear­lier this year, Medi­care pro­posed a rule that will fos­ter more ro­bust com­pe­ti­tion among phar­ma­cies, in­crease ru­ral ac­cess and give se­niors more con­ve­nient in­ter­ac­tions with trained health pro­fes­sion­als.

At is­sue are fa­vor­able deals be­tween phar­macy ben­e­fit man­agers and big- box phar­ma­cies. Medi­care data show that these exclusive ar­range­ments of­ten raise Medi­care costs while boost­ing these en­ti­ties’ prof­its. So it is no sur­prise these multi­bil­lion-dol­lar com­pa­nies are seek­ing to de­rail the rule’s im­ple­men­ta­tion.

Cur­rently, com­mu­nity phar­ma­cies are rou­tinely be­ing de­nied the op­por­tu­nity to par­tic­i­pate in “pre­ferred phar­macy” Medi­care drug plan net­works. In­stead, lo­cal phar­ma­cies are of­ten con­trac­tu­ally ob­li­gated to charge higher co­pays than “pre­ferred” phar­ma­cies. As a re­sult, many se­niors are steered to­ward those phar­ma­cies cho­sen by their drug plan. By let­ting any phar­macy will­ing to ac­cept a drug plan’s “pre­ferred phar­macy” terms and con­di­tions par­tic­i­pate, Medi­care will in­crease ac­cess for pa­tients, and we be­lieve, lower co­pays.

This will par­tic­u­larly ben­e­fit se­niors in un­der­served ru­ral ar­eas that of­ten are served only by small in­de­pen­dent phar­ma­cies. Af­ter study­ing data il­lus­trat­ing how the “pre­ferred phar­macy” ex­per­i­ment was ac­tu­ally play­ing out, Medi­care of­fi­cials con­cluded that let­ting more providers par­tic­i­pate as “pre­ferred phar­ma­cies” is the best way to en­cour­age price com­pe­ti­tion and lower Part D costs.

Be­cause many se­niors pre­fer to talk to a phar­ma­cist face to face, Medi­care’s pro­posal will let more se­niors choose be­tween com­mu­nity phar­ma­cies and mail-or­der op­er­a­tions with­out penalty. In ad­di­tion, the pro­posal will give more pa­tients ac­cess to cost-sav­ing med­i­ca­tion-ther­apy-man­age­ment con­sul­ta­tions with com­mu­nity phar­ma­cists— some­thing cur­rently not of­fered to them.

Op­po­si­tion to the over­all pro­posed rule is co­a­lesc­ing around con­cerns about whether cer­tain “pro­tected class” drugs will no longer be cov­ered and whether the num­ber of pre­scrip­tion drug plans will be too limited. The Na­tional Com­mu­nity Phar­ma­cists As­so­ci­a­tion un­der­stands and ap­pre­ci­ates these con­cerns. How­ever, they are un­re­lated to and must be con­sid­ered separately from the “any will­ing phar­macy” and med­i­ca­tion-ther­apy-man­age­ment pro­vi­sions.

The com­mu­nity phar­macy pro­vi­sions of the rule are es­ti­mated to have no Medi­care cost im­pact. We en­cour­age pol­i­cy­mak­ers to sup­port com­pe­ti­tion, im­proved ac­cess and Medi­care sav­ings by im­ple­ment­ing these pro-pa­tient, pro-phar­ma­cist pro­vi­sions.

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