Urge Congress to Support Pharmacy Competition in Medicare Part D
Are your health care choices being made by pharmaceuutical middlemen and mail order pharmacies? Protect access to prescription medications from local pharmacies. Contact your Members of the U.S. House of Representatives TODAY!
Pharmacists play a vital role in patient’s lives every day. We want to hear your stories about the impact your local pharmacy has had on your health and your community.
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The Centers for Medicare and Medicaid Services (CMS), the agency which runs Medicare, has confirmed that seniors enrolled in Aetna and Coventry drug plans are eligible to change plans during a special enrollment.
Many seniors are finding that the pool of network pharmacies in these plans is much smaller than was advertised during the open enrollment period. Many pharmacies that were advertised by Aetna and the Medicare plan finder as “in network” are in fact out of network, causing beneficiaries to pay higher out of pocket costs or find a new pharmacy to fill their current prescriptions.
Affected seniors wishing to change plans can call 1-800-MEDICARE (633-4227) and tell the customer service representative that they need to select a new plan due to false, inaccurate, or deceptive information provided on Medicare’s plan finder during the 2014 open enrollment period.
A sample letter that you can personalize and send Senators and Representatives is available here (click here to submit by email), and a sample letter to the editor that can be submitted to local newspapers to raise awareness of the issue is available here.
Support Pharmacy Choice in Medicare
Currently, some part D plans offer "preferred" pharmacies that are able to offer lower levels of consumer cost sharing than other network pharmacies. These preferred pharmacies are cherry picked by the plans even though other pharmacies are willing and able to accept the same contractual terms and conditions as the preferred pharmacies and willing to offer consumers the same cost sharing levels. Yet, even in these medically underserved areas the plans deny willing pharmacies this opportunity, necessitating a legislative remedy from Congress.
Support Fair Reimbursements to Pharmacies to Maintain Patient Access
Click here to send an email to your members of Congress to urge them to co-sponsor H.R. 4437, the Generic Drug Pricing Fairness Act of 2014. This bipartisan legislation would help ensure insurance reimbursements to pharmacies better reflect market conditions.
Patients need reliable access to community pharmacies, which need fair reimbursement to stay in business. About 80 percent of drugs dispensed are generics, which pharmacists promote to help save beneficiaries and Medicare money.
Prices for many generic drugs are skyrocketing by 1,000% or more virtually overnight, yet Medicare drug plan middlemen known as pharmacy benefit managers (PBMs) may wait months to update reimbursement. That leaves independent community pharmacies with losses of $40 to $100 or more per prescription. Such losses are unsustainable for community pharmacies or any other small business.
Urge Congress to Recognize Pharmacists as Healthcare Providers
Urge your members of Congress to support H.R. 4190 to recognize pharmacists as healthcare providers under Medicare. Millions of Americans lack adequate access to primary health care because of primary care physician shortages in their communities, despite many of these patients having health insurance coverage. With an additional 36 million individuals potentially gaining health coverage under the Patient Protection and Affordable Care Act (PPACA), the physician shortages will only be exacerbated. The Association of American Medical Colleges has projected that there will be more than 91,000 fewer doctors than needed to meet demand by 2020.
Pharmacists are capable of playing a greater role in the delivery of health care services. Pharmacists who utilize their education, training, and license can provide services that include health and wellness screenings, managing chronic diseases, administering immunizations, medication management, and working in and partnering with hospitals and health systems to advance health and wellness and helping to reduce hospital readmissions.
The lack of pharmacist recognition as a provider by Medicare limits payment for services provided by pharmacists, thereby limiting patients' access to these essential services.
Fight4Rx™ is a non-partisan grassroots effort of the National Community Pharmacists Association aimed at educating patients about the value of their local community pharmacy.
Pharmacists play a role every day in the lives of patients by improving health care while reducing costs. With health care issues taking center stage in Washington, DC, it is vital that patients remain engaged in protecting their access to safe and affordable medicine. Fight4Rx™ provides you with the tools you need to learn about the changing health care market, and how your community pharmacy plays a key role.
Consumer surveys conducted by J.D. Power and Associates, Consumer Reports, and Boehringer Ingelheim consistently reflect that independent community pharmacies garner among the highest customer satisfaction scores, surpassing national, publicly traded pharmacy chains and the most common, volume-driven mail order pharmacies.
Pharmacy benefit managers, or PBMs, act as an intermediary between the payer and everyone else in the healthcare system. They generally make money through service fees from large customer contracts for processing prescription claims, operating mail order pharmacies, and negotiating prices with drug makers. Go to whorunsmydrugplan.com to learn more.
For more information on Fight4Rx™, please email us at
Fax to 703-683-3619
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