A new report to Congress from the Medicare Payment Advisory Commission (MedPAC) offers fresh evidence that when patients take their medication as prescribed they are healthier and costly medical interventions such as hospitalizations are avoided. Central to proper medication use is choosing a pharmacist and pharmacy that best works for the patient and that is at the heart of bipartisan legislation recently introduced – The Ensuring Seniors Access to Local Pharmacies Act (H.R. 4577). Conversely, when patient-pharmacist interactions are undermined, medication adherence and health outcomes can suffer.
H.R. 4577 would allow Medicare beneficiaries living in medically underserved areas greater choice of pharmacy. Many seniors are enrolled in Medicare Part D prescription drug plans that feature “preferred pharmacies.” Only those pharmacies designated by the plan as “preferred” are authorized to offer beneficiaries discounted copays, sometimes as low as $0.
Independent community pharmacies are often left out of these sweetheart deals between plan sponsors and Big Box pharmacy chains. Community pharmacists have frequently contacted plan sponsors and offered to match the pricing and other contract terms of “preferred” pharmacies in order to continue serving patients who may have relied upon them for years, even decades. Their offers are usually declined or ignored.
This situation has especially harmed seniors and their caregivers in medically underserved areas, particularly rural ones in which the independent community pharmacy may be the only pharmacy option for miles around. These patients are forced to choose between paying higher copays or traveling great distances for their medication.
A simple search of the Medicare Plan Finder website reveals many instances of this problem. For example, in Florence, Ore. (population: 8,466) Medicare beneficiaries live within one mile of five different pharmacies, on average, but must travel more than 40 miles to reach a “preferred” pharmacy in either the Humana Enhanced or Humana Preferred Rx drug plan
Here is one of many real-world examples of how this is playing out. An elderly couple in northeastern Alabama switched Part D drug plans and found that the community pharmacy they used for a decade was not a “preferred” pharmacy under their new plan. They had all their prescriptions transferred to the nearest Big Box “preferred” pharmacy 31.8 miles away from their home. Recently their daughter made the 63.6 mile roundtrip only to find out that two prescriptions were left out of their bag. So of course they had to return the next day to retrieve their medication. Two trips, two days, 127 miles!
H.R. 4577 would alleviate this problem by allowing community pharmacies to offer patients the plan’s discounted or “preferred” copays, provided that the pharmacy is located in a medically underserved area and is willing to accept the plan’s terms and conditions.
Supporters of the bill include leading national health and consumer advocates including Consumers Union, HealthHIV, Medicare Rights Center, National Grange, National Senior Citizens Law Center and National Rural Health Association.
To undermine H.R. 4577, middlemen known as pharmacy benefit managers (PBMs) are engaging in scare tactics to frighten seniors. (“Drugstore Owners Force Congress to Choose Between Them and Seniors,” June 20, 2014.) They claim the bill would eliminate Medicare drug plans and raise costs. Neither charge is true. The real reason the PBMs are upset is because H.R. 4577 could indirectly reduce their profits.
When patients are allowed to choose a pharmacy that best meets their needs, they typically choose a local pharmacy where they can have a face-to-face interaction, as opposed to a mail order pharmacy that is owned by the PBM (which in itself raises conflict-of-interest questions). In fact, Medicare officials received so many complaints about poor service from mail order pharmacies that they were compelled to air them publicly on their website. Since PBM-owned mail order pharmacies fail to win over many patients voluntarily, they sometimes mandate their use or incentivize their use by putting up artificial barriers – such as telling seniors they must travel 20 miles or more to reach a “preferred” pharmacy unless they opt for mail.
We commend Reps. Morgan Griffith (R-Va.) and Peter Welch (D-Vt.) for introducing H.R. 4577 and thank the 34 cosponsors whose ranks are growing nearly every day. Working together we can help seniors achieve positive health outcomes and benefit from expanded pharmacy choice and competition in Medicare.