Will CMS’s Part D Rule Add Risks for Preferred Pharmacies?

CMS is drawing mixed responses to its November 16 release of proposed policy revisions to the Medicare Advantage (MA) and Medicare Part D programs for 2019.  The Pharmaceutical Care Management Association (PCMA), said in a statement the next day that, while it continues to review the agency’s lengthy proposal, the group is “initially encouraged by provisions that promote the use of lower-cost generics and biosimilars and make it harder for at-risk patients to go drugstore shopping for opioids,”

Yet PCMA, the PBM trade association, was not entirely pleased with its first read of the 713-page draft regulations.  New “any willing pharmacy” requirements outlined in CMS’s proposed rule “could put at risk the choice and affordability of preferred pharmacy plans,” the group said.  “Protecting the stability of those plan options should be a top priority for regulators.”

CMS said it intends to clarify “that the any willing pharmacy requirement applies to all pharmacies, regardless of how they have organized one or more lines of pharmacy business.”  CMS said it also aims to refine definitions of retail and mail-order pharmacies.

CMS in its draft rule proposes to: allow midyear formulary changes; revise Part D tiering exceptions; and encourage the use of lower cost drug alternatives.