Pharmacists Express Concerns Over Restrictive Medicare Drug Plans

ALEXANDRIA, Va., Nov. 21, 2011 /PRNewswire-USNewswire/ -- Many of the current "restricted network" Medicare Part D prescription drug plans, which limit patients to a small number of pharmacies, are deceptively marketed to patients and lack adequate pharmacy access for rural Americans, the National Community Pharmacists Association (NCPA) said today.


The 2010 announcement of the Humana Walmart plan introduced restricted network pharmacy plans to Medicare Part D. This fall, similar plans have been introduced, such as Aetna CVS/pharmacy, Rite Aid EnvisionRx Plus, and First Health Part D Value Plus, bringing the total number of such plans to six.

NCPA has raised with Medicare officials two primary problems with the plans. First, the plans are being marketed to patients and featured on Medicare's Plan Finder without making clear that the lowest advertised drug prices are only available at relatively few, selected pharmacies. Second, the restricted network plans may discriminate against patients in rural communities in conflict with the agency's pharmacy access requirements. Nearly all of the plans are centered on national pharmacy chains that cater to large cities and suburban areas.

"From day one, these overly restrictive drug plans have raised questions about ensuring adequate access to pharmacy care, which is why NCPA has opposed them," said NCPA CEO B. Douglas Hoey, RPh, MBA. "We urge Medicare officials to consider these marketing and patient access concerns and take action in the interest of seniors."

NCPA summarized these and other issues in a letter recently sent to the U.S. Centers for Medicare & Medicaid Services (CMS). The group is asking the agency to correct the Medicare Plan Finder tool to clarify that lower-cost prescription drug cost sharing is only available at the preferred pharmacy; and to require restricted network plans to openly and transparently state in all communications that patients are required to go to the preferred pharmacy in order to obtain the advertised drug costs.

"We encourage every Medicare beneficiary to talk to a community pharmacist about choosing the right Medicare drug plan," Hoey added. "Pharmacists can be a tremendous resource to Medicare patients by educating them about the enrollment process and helping them 'plug in their drugs' using Medicare's Plan Finder tool at  Only then can seniors, and their caregivers, rest assured that they are enrolled in the plan that best meets their individual health needs."

The Medicare Part D plan open enrollment season is Oct. 15Dec. 7, 2011.

The National Community Pharmacists Association (NCPA®) represents the interests of America's community pharmacists, including the owners of more than 23,000 independent community pharmacies. Together they represent a $93 billion health care marketplace, dispense nearly 40% of all retail prescriptions, and employ more than 315,000 people, including 62,400 pharmacists.  Independent community pharmacists are readily accessible medication experts who can help lower health care spending. They are committed to maximizing the appropriate use of lower-cost generic drugs and reducing the estimated $290 billion that is wasted annually by improper medication use. To learn more go to or read NCPA's blog, The Dose, at

SOURCE National Community Pharmacists Association