James Kovacs have authored a evaluating the Medicare Part D preferred pharmacy network model and CMS’ current proposed rule changes for the Medicare Part D program fiscal year 2015.
The paper finds that:
By passing the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Congress fully intended to provide beneficiaries broad pharmacy access through an any willing pharmacy (“AWP”) provision that permits willing pharmacies to participate in networks. The goal was to ensure that beneficiaries had access to a broad range of pharmacies and enhanced choice, competition, and service.
Restricted pharmacy networks limit access, increase costs to beneficiaries, and diminish the level of service. These services are even more critical as pharmacies perform an increasingly critical role in delivering healthcare and reducing costs as envisioned by the Affordable Care Act (“ACA”).
The proposed Medicare regulations restore Congress’ original intent and will enhance the delivery of services to beneficiaries without increasing costs.
The critics of the reforms have manufactured several studies that are misguided and cannot rebut the data that CMS relies on. Rather, the facts indicate that expansion of services through AWP is likely to reap greater benefits for Part D beneficiaries.
“The reforms could not be more timely,” said David Balto. “Consumers are paying more and getting less in restricted networks. Medicare beneficiaries benefit when they have complete access to the services community pharmacies provide.”
The authors point out that “consumer choice drives market competition and improvements in quality. Allowing beneficiaries open access and the ability to choose between numerous pharmacies which offer valuable services will improve health outcomes, costs, and beneficiary satisfaction.”