Reintroduced Legislation Seeks to Expand Seniors’ Pharmacy Choice, Access

Reintroduced bipartisan legislation by representatives Peter Welch (D-Vt) and Morgan Griffith (R-Va) would expand seniors’ access to lower co-pays for prescription drugs at their pharmacy of choice in underserved areas.

The Ensuring Seniors Access to Local Pharmacies Act (HR 4946), which was first introduced in 2015, would require that community pharmacies in medically underserved areas or health professional shortage areas be allowed to participate in Medicare Part D preferred networks. This would allow seniors in these areas to access lower co-pays at any pharmacy willing to accept the Medicare Part D drug plan’s “preferred pharmacy” terms and conditions.

According to the National Community Pharmacy Association (NCPA), such a policy would enhance seniors’ pharmacy choice and access by also allowing the patient to choose which pharmacy best suits their needs. Community independent pharmacies, which are often predominantly located in underserved areas, face challenges due to exclusions from these preferred pharmacy networks. A study published in JAMA Internal Medicine recently found that independent pharmacies are at greater risk of closure, especially those that serve disproportionately uninsured or publicly insured residents with Medicare or Medicaid.

“Pharmacy benefit manager (PBM) ‘preferred network’ policies often limit Medicare patients’ access to needed prescription drugs and the expert counseling provided by independent community pharmacies,” B. Douglas Hoey, RPh, MBA, chief executive officer of NCPA, said in a statement. “But patients should be able to use the pharmacy of their choice if the pharmacy is willing to accept the drug plan’s contract terms and conditions.”

If passed, the legislation will also require claims level reimbursement transparency, giving pharmacies a clearer understanding of their reimbursement. Language included in the bill will prevent PBMs from reimbursing their affiliated pharmacies more than they do other pharmacies and to ensure reimbursement covers acquisition and dispensing costs.

“Allowing ‘any willing pharmacy’ to participate in Medicare drug plan preferred networks and ensuring reasonable reimbursement are vital components to changing the pharmacy payment model to a system that better serves patients,” Hoey added. “We applaud Reps. Welch and Griffith for the Ensuring Seniors Access to Local Pharmacies Act and their work to increase choice for patients and transparency into PBM tactics.”

References

H.R. 793 Ensuring Seniors Access to Local Pharmacies Act of 2015. NCPA’s website. http://www.ncpa.co/pdf/hr793-preferred-network-access.pdf. Accessed November 1, 2019.

NCPA Supports Welch-Griffith Bill Expanding Seniors’ Access to Lower Drug Copays [news release]. NCPA’s website. https://www.ncpanet.org/newsroom/news-releases/2019/10/31/ncpa-supports-welch-griffith-bill-expanding-seniors'-access-to-lower-drug-copays. Accessed November 1, 2019.