Survey: Part D 'preferred pharmacy' provision driving rural seniors away from community pharmacy

ALEXANDRIA, Va. — A survey of community pharmacists suggests that "preferred pharmacy" Medicare Part D drug benefit plans may pose challenges for seniors in rural communities. The finding comes shortly after similar questions were raised at the January public meeting of the Medicare Payment Advisory Commission, Congress' advisory board on Medicare issues, the National Community Pharmacists Association noted Thursday. 

"Any legitimate pharmacy provider willing to accept a health plan's terms and conditions, including reimbursement, should be allowed the opportunity to serve that plan's members, including as a preferred pharmacy," stated Douglas Hoey, CEO of NCPA. "Unfortunately, in the current environment, seniors may unwittingly be coerced by co-pays that are only available in 'preferred' pharmacies that may be 20 miles away, while much closer, locally owned pharmacies are shut out. In effect, Medicare's access standard is a double standard — one by which some plans rely on independent pharmacies to meet pharmacy network access requirements while not allowing those same pharmacies to serve patients on equal footing.

Some seniors are surprised to find that they are enrolled in Part D drug plans whose preferred pharmacies offering the lowest, advertised co-pays may be 20 miles or more from the seniors' home, pharmacists reported. And nearly all community pharmacy owners/operators (91%) said they are not offered the opportunity to participate as a preferred pharmacy.

Approximately 1,800 rural independent pharmacies serve as the only pharmacy provider in their community, with the next closest pharmacy many miles away.

Virtually every pharmacist (98%) said their patients experienced confusion about the difference between preferred and nonpreferred (or "network") pharmacies, with 76% of pharmacists attributing the patients' confusion to the plan's marketing activities.

While the Medicare Part D program does require plans to maintain a pharmacy network that meets minimum access standards, these requirements do not apply to the preferred pharmacies designated by the plan, NCPA noted. 

At a Jan. 10 MedPAC meeting, Commission staff said one reason they were "keeping an eye on this trend is because this could have an effect on beneficiaries' access to medications." In particular, questions were raised at the meeting about preferred pharmacy plans' potential impact on patient access to medication, beneficiary confusion over the difference between a preferred pharmacy and a network one, and the cost impact of differential co-pay levels. "Access and cost implications of tiered pharmacy networks are not yet known, and we will continue to monitor the plans' use of tiered pharmacy networks and the effects on beneficiaries' access to medications," MedPAC staff noted.

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