Alexandria, Va. - Jan. 19, 2012
Medicare officials should swiftly authorize a Special Enrollment Period to allow patients to enroll in a new Medicare Part D prescription drug plan if the patient believes that material misrepresentations led them to sign up for a "preferred network" plan with inadequate pharmacy access, the National Community Pharmacists Association (NCPA) said today.
Since the start of the 2012 plan year on January 1, local pharmacists have heard repeated complaints from patients saying they were misled by Medicare drug plan advertising with regard to certain preferred networks. Patients claim that at the time of enrollment they relied on material misrepresentations on Medicare Plan Finder (the online portal maintained by the Centers for Medicare & Medicaid Services, or CMS), online plan advertising, and/or were misled by enrollment agents regarding the availability of low, advertised medication co-pays. Now these seniors find that, when they go to their pharmacy of choice in the plan's network, the advertised co-pays are not available because that provider is not one of the plan's "preferred" pharmacies.
"NCPA previously warned that these overly restrictive Medicare drug plans were being deceptively marketed to patients and lack adequate pharmacy access for Americans in rural or underserved areas. While not surprising, it is unfortunate that our concerns were validated within the first few days of the 2012 plan year," said NCPA CEO B. Douglas Hoey, RPh, MBA. "Now, seniors are going to the community pharmacy that they have relied on for years, sometimes decades, only to be told that they must travel 20 miles or more to obtain the lowest-advertised co-payments for their medication.
"While CMS is working with us to address individual patient concerns, we believe as a matter of fairness that all enrollees in these restrictive network plans should have the chance to reevaluate whether this is the right plan for them," Hoey added. "Every day about 10,000 Americans turn 65 and are eligible to enroll in a Medicare drug plan. Medicare should allow seniors who feel that they've been duped the same choice as those just entering the program. In addition, CMS should implement preventative steps to avoid a repeat of this situation next year."
NCPA is working with Medicare officials in hopes of addressing these concerns. The association recently sent a letter to CMS asking the agency to agree to a Special Enrollment Period for these patients this year and to take action to prevent similar, misleading marketing practices in future years. Along with its letter, NCPA provided the agency with a compilation of problems patients and pharmacists are experiencing.
The 2010 announcement of the Humana Walmart plan introduced restricted network pharmacy plans to Medicare Part D. In 2011, similar plans were introduced, such as First Health Part D Value Plus, Aetna CVS/pharmacy and Rite Aid EnvisionRx Plus, bringing the total number of such plans to six.
NCPA has expressed to Medicare two primary concerns with the restricted plans. First, they are marketed without making clear that the lowest advertised prices are only available at a relatively small number of pharmacies. Second, these plans may lack adequate pharmacy access for patients in underserved or rural communities. Independent community pharmacies rarely, if ever, are afforded an opportunity to meet the plans' pricing and contract terms.
NCPA is urging community pharmacists to encourage and assist their patients in filling out a CMS complaint form, calling 1-800-MEDICARE or filing a complaint via NCPA's website.
The National Community Pharmacists Association (NCPA®) represents the interests of America's community pharmacists, including the owners of more than 23,000 independent community pharmacies. Together they represent a $93 billion health care marketplace, dispense nearly 40% of all retail prescriptions, and employ more than 315,000 people, including 62,400 pharmacists. Independent community pharmacists are readily accessible medication experts who can help lower health care spending. They are committed to maximizing the appropriate use of lower-cost generic drugs and reducing the estimated $290 billion that is wasted annually by improper medication use. To learn more go to www.ncpanet.org or read NCPA's blog, The Dose, at http://ncpanet.wordpress.com.
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