NCPA: Preferred pharmacy networks don't necessarily net prescription savings

ALEXANDRIA, Va. — The Medicare Part D program and taxpayers often pay more when prescription drugs are obtained through "preferred" pharmacies and mail order than they would if the same prescriptions were filled through other, "non-preferred" pharmacies, according to a cost comparison made by the National Community Pharmacists Association released Thursday using the Medicare Plan Finder website. The findings come shortly after recently proposed requirements that officials with the U.S. Centers for Medicare & Medicaid Services suggested for Medicare prescription drug plans in 2015.

"This analysis suggests that neither preferred pharmacies nor mail order are the bargains for Medicare that their proponents claim," NCPA CEO Douglas Hoey, said. "We commend CMS for its recent, enhanced scrutiny of both preferred pharmacy plans and mail order. We encourage the agency to follow through on its proposed changes, which should produce greater choice and pharmacy competition for beneficiaries in 2015."

NCPA staff chose one commonly purchased PDP, the AARP Medicare Rx Preferred drug plan, and entered into Plan Finder four of the most-prescribed drugs: generic version of Lipitor—atorvastatin calcium Tab 20mg 90-day supply; generic version of Plavix—clopidogrel Tab 75mg 90-day supply; diovan—Tab 80mg 90-day supply; and Nexium—Cap 40mg 90-day supply. The costs were compared between preferred, mail order and non-preferred pharmacies in nine cities across the country.

According to the NCPA analysis, 89% of the time, preferred pharmacy costs to Medicare were higher than those of non-preferred pharmacies. Mail order costs to Medicare exceeded those of non-preferred pharmacies 100% of the time.

"Independent community pharmacies are often excluded from a plan's list of 'preferred pharmacies' and thereby denied the ability to offer patients the lowest, advertised co-pay," Hoey noted. "Community pharmacy owners have contacted plans and offered to accept the same contract terms and conditions, including reimbursement, as preferred pharmacies, but are routinely rebuffed or ignored. This situation creates problems for patients because independent community pharmacies are frequently located in rural and other underserved areas, from which the closest preferred pharmacy may be 20 miles or further away.

That problem may be exasperated in the near term by how popular preferred pharmacy plans are becoming for enrollees. According to a recent Drug Channels analysis, 60 of 2014's 106 Medicare Part D Prescription Drug Plans have a preferred pharmacy network design, and 75% of seniors have enrolled in one of these 60 plans. 

 

 

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