CMS BLOG
February 11, 2016
By:
Sean Cavanaugh, Deputy Administrator and Director of the Center for Medicare,
CMS
Making Preferred Cost Sharing Pharmacies More
Available
The benefits Medicare provides are only as good
as the access beneficiaries have to them. That’s why beneficiary access is a
founding principle of our work at CMS.
Last year, we heard concerns that some
beneficiaries did not have ready geographic access to preferred cost-sharing
pharmacies. Increasingly, Part D plans are creating smaller networks of
pharmacies within their larger networks and offering lower cost-sharing
arrangements to beneficiaries who use these preferred cost-sharing pharmacies.
Plans market these lower cost-sharing arrangements, which are appealing to
beneficiaries looking to save money on their prescription drugs. However, in
some instances, these pharmacies were not geographically accessible to the
beneficiaries in the plan.
In our analysis
of Part D beneficiary access to preferred cost-sharing pharmacies (https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Downloads/PCSP-Key-Results-Report-Final-v04302015.pdf),
which was released in April 2015, we analyzed the
availability of these pharmacies to Part D enrollees. We were pleased to learn
that most Part D enrollees live in areas where Part D plans provide reasonably
robust preferred cost-sharing pharmacy networks. However, some beneficiaries in
all areas, but particularly those in urban areas, face limited, or in some
instances, no geographic access to preferred cost-sharing pharmacies.
We took action. In last year’s (2016) Medicare
Advantage Rate Notice and Part D Call Letter (https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/Announcement2016.pdf), we announced that we would: 1) work with outlier plans
to address our concerns about access and marketing; 2) require plans whose
preferred cost-sharing networks are outliers (i.e., they offer significantly
less access to preferred cost-sharing pharmacies) in 2016 to disclose in
marketing materials that their plan offers less access; and 3) publish access
levels for each plan offering a preferred cost sharing benefit structure.
Plans responded. We are pleased to share that, based
on data we are posting on cms.gov today (https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/index.html), access to preferred cost-sharing pharmacies has
improved. The bottom 10th percentile of plans in 2016 offer access within two
miles to 71% of urban beneficiaries, as compared to 40% of beneficiaries in
2014.
This is just one example of
ways CMS and Part D sponsors are working together to improve Medicare
beneficiaries’ access to benefits.
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