On May 31, 2006, the National Community Pharmacists Association (NCPA) submitted a comment letter to the Centers for Medicare & Medicaid Services (CMS) regarding the marketing guidelines for Part D plans in 2007
Contract Year 2007 Marketing Guidelines
On March 6, 2006, the National Community Pharmacists Association (NCPA) submitted two comment letters to the Centers for Medicare & Medicaid Services (CMS) on important upcoming issues regarding Medicare Part D.
Formulary Guidance
Transition Guidance
On March 1, 2006, the National Community Pharmacists Association (NCPA) submitted two comment letters to the Centers for Medicare & Medicaid Services (CMS) on important upcoming issues regarding Medicare Part D.
Changes to Part D for 2007
Fraud, Waste and Abuse Requirements
Shortly after President Bush signed the Medicare Rx bill into law (P.L.108- 173), on December 8, 2003, we knew that it would be quite a challenge to explain to our members the significant differences between contracts under the new Part D and the take-it-or-leave-it contracts that had victimized them and their patients offered for the past decade by the giant PBMs.
Initially we took our cue from the then Acting Deputy Administrator of CMS Leslie Norwalk. Norwalk, who today is the deputy administrator spoke on December 10, 2003 at the National Conference of State Legislatures in Washington, D.C. about the new Medicare Rx program, but in particular about the Medicare discount card program.
Norwalk emphasized that the decision of whether to contract with Medicare card sponsors would be up to each pharmacy. Specifically she said, "It's up to you whether or not you contract at a rate that you like. If you don't like the rate, then don't contract. And if you like the rates, fabulous. So, it's really up to you as to whether or not you'd be operating at a loss."
Through our NCPA Contract Clearinghouse and various traditional and e-communications, we have repeatedly emphasized to our members that the dynamic of plan selection under the new law rests with each of the Medicare beneficiaries not with a giant PBM.
This is in stark contrast with the traditional commercial sector where Lear-jetted executives from a giant PBM visit a local employer — hoping they're unfamiliar with the PBM exposes in the Wall Street Journal and elsewhere — to wine and dine them to secure a contract that covers their employees.
The outcome frequently was that hundreds or even thousands of patients in the pharmacy's area were participating in a contract that their employer selected with the PBM.
Pharmacies were often between a rock and a hard place. They often felt that they have a choice of dying now or dying slowly as victims of such one-sided non-negotiable PBM contracts.
Unless a pharmacy is familiar and comfortable with the terms and conditions of a prospective Medicare prescription drug plan (PDP) you would think that pharmacies would wait until September to learn which PDPs have been approved by CMS and which of the approved are offered in their area.
Pharmacies are not obligated to participate in Part D, and they are not obligated to sign any particular Part D PDP contract. In fact, many issues and concerns have emerged with regard to ostensible PDPs' contracts that have been sent to pharmacies since February of this year: Some are solely addenda to existing commercial sector contracts; others require the pharmacy to "opt out" if they do not want to participate in a particular PDP offering; still others try to force the tying of commercial business to the new Part D program; some have threatened pharmacies that if they do not sign now they will never have access; and many do not reflect the terms and conditions required by the new law and its final regulations (e.g., 90-day option, no mandatory mail order, payment for MTMS, payment for delivery and quality assurance services, etc.). Some pharmacies will refuse to sign an ostensible PDP's contract because the offering is so low that it would violate the below cost or predatory pricing laws. Such laws are on the books in 22 states:
| Arkansas | Montana |
| California | North Dakota |
| Colorado | Oklahoma |
| Hawaii | Pennsylvania |
| Idaho | Rhode Island |
| Kentucky | South Carolina |
| Louisiana | Tennessee |
| Maine | Utah |
| Maryland | West Virginia |
| Massachusetts | Wisconsin |
| Minnesota | Wyoming |
Other pharmacies may decide not to sign a prospective PDP's contract because of one or more of the various concerns cited above. Remember to make your own individual business decision and as mentioned, Medicare Part D is a whole new ball game. You will have the opportunity to stress to your patients your appreciation for your trusted provider/patient relationship as well as your interest in continuing it under the Part D benefit.
As Ms. Norwalk reminded policymakers from around the county many months ago: It's your individual decision and you are free to just say no. Evaluate your offers, educate your customer patients, and work with available PDPs that are consistent with your individual business objectives and the goals of your pharmacy practice.
Until next time,
John