NCPA to CMS: Offer special enrollment period for seniors who feel they were duped by preferred networks

January 24, 2012

Medicare patients who believe they were duped into enrolling in a “preferred network” with inadequate pharmacy access should be granted a special enrollment period to sign up for a new Medicare Part D prescription drug plan, the National Community Pharmacists Association told the federal agency in a letter.

Medicare patients who believe they were duped into enrolling in a “preferred network” with inadequate pharmacy access should be granted a special enrollment period to sign up for a new Medicare Part D prescription drug plan, the National Community Pharmacists Association (NCPA) told the federal agency in a letter.

Local pharmacists have been hearing repeated complaints since the Jan. 1 enrollment period began about patients saying they were misled by Medicare drug plan advertising, the NCPA said in a press release.

Some of these patients say they received misrepresentations on Medicare Plan Finder, the online portal maintained by the Centers for Medicare & Medicaid Services (CMS), the NCPA reported.  Others say they were misled by enrollment agents regarding the availability of low, advertised medication co-pays.

“Now these seniors find that, when they go to their pharmacy of choice in the plan’s network, the advertised co-pays are not available because that provider is not one of the plan’s 'preferred' pharmacies,” the NCPA said in a statement.

The NCPA had previously issued a warning about this potential problem, according to NCPA CEO B. Douglas Hoey, RPh, MBA.

“While not surprising, it is unfortunate that our concerns were validated within the first few days of the 2012 plan year,” Hoey said.

He said CMS was working with the NCPA to address the concerns. A spokesperson for CMS declined to comment.

NCPA is also urging community pharmacists to encourage and assist their patients in filling out a CMS complaint form.