AMCP: Proposed Part D Changes Could Undermine Program

Jan 30, 2014, 09:00 ET from Academy of Managed Care Pharmacy

Overdue Change in Protected Classes Overshadowed by Parts Impacting Cost and Access for Beneficiaries

ALEXANDRIA, Va., Jan. 30, 2014 /PRNewswire-USNewswire/ -- The Academy of Managed Care Pharmacy (AMCP) today released the following statement by CEO Edith A. Rosato, RPh, IOM commenting on CMS' recently released draft rule on proposed changes to the Medicare Part D program, as follows:

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"At a time when increasing access to and affordability of health care is a national imperative, the Centers for Medicare and Medicaid Services' Medicare Part D proposed rule for 2015 would seem to be going in the opposite direction.

"The Academy is greatly concerned that all but one of the proposed changes would roll back CMS' recent progress in reducing costs for program administration and increasing beneficiary access to affordable medications. These provisions would end preferred networks, limit access to cost-saving mail order pharmacy, and expand Part D's medication therapy management (MTM) program.

"AMCP is concerned that these changes would increase costs to the program and beneficiaries – the latter primarily by limiting their access to affordable Part D plans. For 2014 more than 75 percent of Medicare beneficiaries have chosen cost-effective Part D plans with preferred networks. Expanding access to prescription drugs at affordable prices should continue to be CMS' goal – reforms should advance access and affordability, not reverse it. Moreover, expanding Part D's MTM program, already underfunded, is unwise without providing additional resources to ensure robust benefits for patients.

"There is a silver lining in CMS' proposed rule. We support its scaling back requirements for medications in three of the six protected classes: antidepressant, antipsychotic, and immunosuppressive medications. When Congress "protects" a class of medicine from competition, plans have almost no room to negotiate price. We commend CMS for explicitly recognizing the positive role that pharmacy and therapeutics (P&T) committees play in selecting safe and effective medications for formularies; indeed, the P&T committee process seeks to optimize medication utilization while ensuring affordability and robust formularies. In these three classes, we commend CMS for allowing P&T committees to do what they do best: develop robust formularies that offer patients access to appropriate and affordable medicines.

"CMS should stay the course and scale back the number of protected classes further. However, regarding changes to preferred networks, mail-order pharmacy and MTM in Part D, we urge CMS to make a swift, but sure course correction."

About AMCP
The Academy of Managed Care Pharmacy is a national professional association of pharmacists and other practitioners who serve society through sound medication management principles and strategies. Our 7,000 members develop and provide clinical, educational and management services on behalf of 200 million Americans. www.amcp.org.

SOURCE Academy of Managed Care Pharmacy



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