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Independent pharmacy lobby weighs in as feds mull ‘grandfather’ status for plans

ALEXANDRIA, Va. Federal agencies enforcing new health-reform mandates must act to preserve patients’ access to the pharmacy of their choice and lower-cost generic medicines, the independent pharmacy lobby urged the government Tuesday.

In a written appeal to three federal agencies, the National Community Pharmacists Association asserted that health plans seeking Grandfathered Health Plan status under the landmark health-reform law enacted earlier this year must maintain patient freedom of choice and ease of access to generics in a reformed healthcare network. Otherwise, urged NCPA acting EVP and CEO Doug Hoey, those plans should lose their special status.

The NCPA sent a letter Tuesday to three agencies that currently are developing criteria for maintaining GHP status following implementation of the massive Patient Protection and Affordable Care Act. The appeal went to the Internal Revenue Service, Employee Benefit Security Administration and Department of Health and Human Services Office of Consumer Information and Insurance Oversight.

The NCPA’s goal, in its own words: to advance “patient choice and greater utilization of generic prescription drugs” as health plans jostle for a central role in a reformed healthcare system. “Providing quality patient care is vital to healthcare reform, and health plans that want to maintain grandfathered health plan status should not be allowed to alter their structure and benefits in ways that undermine those objectives,” Hoey said.

“For example, the face-to-face interaction patients get in their local pharmacies has a proven, positive track record in terms of health outcomes. Changes by health plans that steer patients against their will toward mail-order pharmacies represent more than just ‘reasonable routine changes’ to an existing health plan and should cause them to lose grandfathered health plan status,” Hoey asserted in his letter today. “Similarly, health plans should not be able to maintain grandfathered status when they change their prescription drug formulary designs by creating or expanding a list of ‘specialty medications’ in order to shift patients to a specific mail-order pharmacy.”

Such changes, Hoey added, would limit access to those drugs by plan beneficiaries, since many specialty drugs aren’t available to independent drug stores. “These are more than ‘reasonable routine changes’ and should also cause them to lose their grandfathered status,” he told the federal agencies.

“On the other hand,” Hoey added, “when generic alternatives become available, the brand-name prescription drug is routinely placed in a higher co-pay tier in the drug formulary to promote the use of the generic. That is indeed a ‘reasonable routine change’ and should not be grounds for a plan losing its grandfathered status.”

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