NCPA: Independent pharmacy can benefit health insurance exchanges

ALEXANDRIA, Va. — The National Community Pharmacists Association on Monday touted the benefits community pharmacies can provide for health insurance exchanges once those exchange open in 2014 in a letter addressed to the Department of Health and Human Services.

“Federal and state officials from both parties are making considerable efforts now to make certain that patients will have access to affordable, quality medical coverage when health insurance exchanges open in 2014,” stated NCPA CEO Douglas Hoey. “The services of community pharmacists, such as expert medication counseling, are critical to improving patient outcomes and reducing costs in these plans, as well as those outside of the exchanges.”

NCPA’s comments to HHS included the following recommendations:

  • HHS should adopt the Department of Defense/TRICARE standard for pharmacy access in plans offered through the state exchanges. That minimum standard sets forth an adjusted scale for pharmacy access in urban, suburban and rural communities (e.g., at least 70% of beneficiaries in rural areas on average must live within 15 miles of a participating retail pharmacy);

  • To further ensure access, plans also should consider, where appropriate, designating community pharmacies in low-income, underserved areas as “essential community providers”;

  • To maximize the cost-savings from pharmacy benefit manager disclosure requirements, HHS should issue guidance so health plans get an accurate grasp of the complex, multifaceted revenue streams of PBMs;

  • Specifically as it relates to payments to PBMs by manufacturers and other entities, NCPA suggests a definition of “indirect compensation” to reflect revenue retained by PBMs in addition to rebates; and

  • Adopt a more transparent process for evaluating proposed changes to plans in the health exchanges than the state plan amendment process currently employed in Medicaid. For example, proposed changes could be publicly disclosed in advance of HHS’ ruling on them.

To view the letter in its entirety, click here.


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