Pharmacy groups applaud Part D backpedal

March 11, 2014

AMCP and NCPA are generally relieved that feds won't interfere with drug prices

After weeks of strong bipartisan opposition to changes to Part D rules, federal officials scratched nearly all of the proposed ideas. Most notable was the unpopular proposal to allow federal involvement in negotiations between payers and drug makers.

The Academy of Managed Care Pharmacy (AMCP) and several industry and patient groups applauded the news.

"AMCP, along with hundreds of other Part D stakeholder organizations, successfully argued that the proposed rule would fundamentally change one of our most successful healthcare programs in ways that would have serious, negative consequences for millions of seniors,” CEO Edith Rosato said in a statement.

Price Negotiations

The Medicare Modernization Act (MMA)-which launched Part D-has a rule that prohibits the Centers for Medicare and Medicaid Services (CMS) from intervening with the market negotiations that go on between plans and pharmacies and drug manufacturers. Additionally, MMA does not permit a specific price structure for Part D reimbursement. Although federal involvement in negotiations was proposed, CMS will remain hands-off.

Part D plans were also concerned because HHS was making noises about forcing them into open pharmacy networks with “any willing provider” requirements. While plans are relieved this requirement will not be implemented, the National Community Pharmacists Assn. immediately responded with its concerns.

 

 

“We are deeply disappointed in CMS’ decision not to move forward at this time with the pharmacy choice provision included in its proposed rule,” CEO B. Douglas Hoey said in a statement. “CMS has heard repeatedly from community pharmacists and patients regarding the inadequacies of ‘preferred pharmacy’ drug plans. They have been deceptively marketed and are confusing to patients.”

Preferred networks are one of the tools plans can leverage for more favorable pricing. Forcing any willing provider rules ultimately could have affected costs for seniors.

Protected Drug Classes

Part D advocates are also pleased to see that the protected classes of drugs will remain as-is. Sponsors currently must cover “all” or “substantially all” of the protected drug classes identified by CMS:

• anti-convulsants;

• antidepressants;

• anti-cancer;

• anti-psychotics;

• anti-retrovirals; and

• immunosuppressants for the treatment of transplant rejection.