Amid challenging trends in drug prices and formularies, independent pharmacy advocates are pushing for a new "any willing" provider mandate in Medicare Part D.
The National Community Pharmacists Association is in the midst of a national campaign to build support for the Ensuring Seniors Access to Local Pharmacies Act, a bill that would require Medicare drug plan sponsors to contract with any pharmacy as a preferred provider in medically underserved areas.
"The Medicare pharmacy choice proposal, H.R. 4577, is popular with voters, supported by key consumer advocates and has strong, bipartisan backing from dozens of cosponsors," said Douglas Hoey, CEO of the National Community Pharmacists Association.
Co-sponsored by 32 Republicans and 27 Democrats, the bill would extend to Part D pharmacy networks the concept of "any willing provider" contracting, whereby insurers must include all interested providers in their networks. Under the bill, "any willing pharmacy" serving in a federally-designated medically underserved region could become a preferred network pharmacy in a Part D drug plan with the same terms, conditions and reimbursement as any other preferred pharmacy network offered in the area.
The proposal is in response to the trend of large preferred pharmacy networks in Part D, from mail-order pharmacies to partnerships with the likes of Walmart -- shifts which the National Community Pharmacists Association insists has left smaller, independent pharmacies struggling and seniors in many rural areas with fewer choices.
"Independent community pharmacies are often excluded by health plans from such arrangements, even though these pharmacies are predominantly located in underserved areas," the group argues.
The Ensuring Seniors Access to Local Pharmacies bill is a sign of a new business battleground to serve the growing population of seniors.
On the one hand, Part D sponsors have found some efficiencies with national pharmacy benefits managers -- one study estimated that preferred pharmacy networks will save $800 million in federal drug spending this year -- and plans may also be able to find national networks valuable when it comes to costly specialty medications.
On the other hand, leaving out the option for local and independent pharmacies or offering too few plans with them, raises the risk of alienating consumer bases.
The National Community Pharmacists Association argues that that's the case, but sees an "any willing pharmacy" law as the best solution. The group cites a recent poll that found 75 percent of 1,000 voters support the idea of requiring parity in contracting for community and national pharmacies.
Congress could vote on the measure later this summer after August recess.