Medicare Drug Plans Limit Pharmacy Choices for NJ Seniors

Seniors in New Jersey and those living in rural areas are finding it harder to buy medications at their local community pharmacies due to changes in Medicare drug plans. 

Mark Riley, President of the National Community Pharmacists Association, blames arrangements dictated by health insurance middlemen, called Pharmacy Benefit Managers (PBMs), with forcing some seniors to pay more or stop using the pharmacy of their choice. He said PBMs have created Preferred Networks where only a small percentage of the pharmacies wind up with a "preferred" status, generally being very large national chains. "It's locked the local smaller community independent pharmacies particularly out of those networks even though they're willing to accept the same terms in terms of payment. They're not asking for some special higher payment. They're just asking to be in the network and they're not even given a chance to be in that network," he said.

NCPA is urging Congress to enact new bi-partisan legislation to expand seniors access to lower co-pays across the network. "It's H.R. 4577, and what the bill does is in medically under served areas, which is probably 70 percent of the land mass in the United States, it would allow pharmacies that are willing to accept the same payment and terms to be in the Preferred Network," said Riley, adding that even medicare officials agree Preferred Networks haven't saved as much money as they anticipated and that it doesn't make sense to reduce access to seniors when it's not costing the government any more money.

"We feel these Preferred Networks are advantaging the huge corporate pharmacies and the plan sponsors at the expense of seniors in their choice. It seems to me seniors are being herded like cattle and told where they have to do everything and with the other pharmacies being blocked out, it actually reduces competition not increase it," Riley said.  He's urging seniors to press New Jersey's Congressional Delegation to support proposed changes to give seniors more access to pharmacies and reduce co-pays.

More information about this issue can be found at www.ncpanet.org/pharmacychoice.