NCPA supports CMS rules for Medicare Part D plans


NCPA responds to CMS' final call letter for 2014 PDPs


The Centers for Medicare and Medicaid Services (CMS) issued its

 that provides recommendations and requirements for Part D prescription drug plans (PDPs) for next year.

In response, the National Community Pharmacists Association (NCPA) has announced it support of CMS approaches to pharmacy audit practices, preferred pharmacy networks, and auto-shipping by mail order.

Pharmacy audits should be conducted to recoup funds associated with waste, fraud, and abuse; however, some audits have recouped significant amounts from community pharmacies over clerical issues, said B. Douglas Hoey, RPh, MBA, NCPA’s CEO, in a press release.

“We agree with Medicare’s statement that Part D plans should only recoup the full amount of a prescription claim under certain circumstances, such as a fraudulent or duplicate claim. When a pharmacist dispenses the right drug to the right patient for the correct cost, it should not be a punishable offense,” Hoey said.

Many independent pharmacies and regional chains have been locked out of drug plans tied to preferred pharmacy networks, resulting in access problems for Medicare beneficiaries. These preferred pharmacy networks have also contributed to higher costs for Medicare, NCPA claims.

“We appreciate Medicare’s statement that it believes that the best way to encourage price competition and to lower costs is to allow any willing pharmacy to participate in preferred networks,” Hoey continued. “We hope that Part D plans will take that suggestion to heart.”

In addition, auto-shipping by mail-order pharmacies has been problematic. Wasteful spending can occur if the patient has not been contacted prior to shipping, and drugs can be wasted. CMS is requesting that retail and mail-order pharmacies obtain patient consent before shipping medications.

While this new recommendation has raised concerns about beneficiary adherence, CMS believes that just the opposite will result - patients will demonstrate better medication adherence if they have verified the need for the medication, as outlined in the CMS call letter.

NCPA also suggests that plan sponsors consider implementing neutral co-pay benefit designs to spur pharmacy competition, rather than simply pushing patients toward mail order.

“Recent research found that community pharmacies provide 90-day medication supplies at lower cost than mail-order pharmacies and that local pharmacists substitute lower-cost generic drugs more often when compared to mail-order pharmacies,” Hoey said.


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