Over the next few weeks, you will be receiving service contracts from one or
more prospective Prescription Drug Plans (PDPs) trying to build networks for the
Medicare Part D benefit. Some may propose reimbursement rates that are
financially unacceptable to your personal business.
Medicare Part D is a
whole new ball game. Group enrollments will no longer be solely controlled by
PBMs. Some seniors can change plans on 30 days notice.
After the
Centers for Medicare and Medicaid Services announces the approved PDPs in
September and the enrollment process begins in November, you can educate your
customers about the plans you have accepted. You can express your
appreciation to them for your trusted provider-patient relationship and the
desire to continue it under the Part D benefit. We believe many patients
will choose from the set of plans accepted by their current
pharmacists.
You have a choice to “just say no.” If you receive
unfavorable contract offers from one or more PDPs, NCPA wants you to know that
you have a choice. (Some of these contracts from prospective PDPs may be
“opt-outs.” You could find yourself in a network you don’t want to be in if you
don’t decline to participate in writing.)
You have a choice to reject
unfair agreements. The Medicare enrollment process empowers you to keep
your customer base without accepting unfair contracts. Evaluate your
offers. Educate your customers. Work with plans that work with
you.