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Radar On Market Access: Independent Pharmacies Push Bill to Increase Access to Part D Preferred Networks

Posted by Leslie Small on Nov 19, 2019

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In the Medicare Part D market in 2020, preferred cost-sharing pharmacy networks continue to be king. But because independent pharmacies often find themselves shut out of such arrangements, recently introduced legislation is seeking to change that dynamic.

"The Part D plans have fully adopted preferred networks over the last few years," Adam Fein, Ph.D., president of Pembroke Consulting, Inc., and CEO of Drug Channels Institute, tells AIS Health. "The [retail] chains obviously have some different strategies but are looking for the foot traffic" that comes from offering lower cost sharing as part of a preferred network.
 
Meanwhile, many independent pharmacies and the pharmacy services administrative organizations (PSAOs) that represent them in negotiations with health plans are moving away from preferred Part D networks.

Fein says they "have concluded that the incremental traffic they're going to get is not worth the profit they're going to sacrifice."

Ultimately, "I think the open question is, will this create access problems to preferred networks, and does CMS care?" he says.

The National Community Pharmacists Association (NCPA) isn’t counting on regulatory intervention. The organization is supporting a bill — introduced last month by U.S. Reps. Peter Welch (D-Vt.) and Morgan Griffith (R-Va.) — which would allow any pharmacy located in an underserved area to participate in a Part D preferred network as long as that pharmacy accepts the terms and conditions.

"We're not asking for different terms and conditions, [or] higher reimbursement; we’re just asking to be able to see what the terms and conditions are to be in the preferred network and then make our best decision if we want to participate or not," says Ronna Hauser, the president of policy and government affairs operations at NCPA.

The Pharmaceutical Care Management Association opposes the bill.

"The proposed any willing pharmacy provisions threaten the effectiveness of selective contracting with pharmacies as a tool for lowering costs," says as statement from the PBM trade group.


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Topics: Industry Trends, Provider, Payer