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NCPA seeks special enrollment period for Part D patients from CMS


ALEXANDRIA, Va. — The National Community Pharmacists Association is calling for the Centers for Medicare and Medicaid Services to allow senior patients to enroll in a new Medicare Part D prescription drug plan via a special enrollment period, particularly if patients believe that "material misrepresentations" led them to sign up for a "preferred network" plan with inadequate pharmacy access.

The NCPA said many patients claimed that at the time of enrollment, they relied on Medicare Plan Finder, the online portal maintained by the government agency, as well as online plan advertising and/or enrollment agents regarding the availability of low, advertised medication co-pays. Through misrepresentations from these sources, NCPA said, seniors have found themselves experiencing issues with access because when they visit their pharmacy of choice in the plan’s network, the advertised co-pays are not available because that provider is not one of the plan’s “preferred” pharmacies.

NCPA said it recently sent a letter to CMS asking the agency to agree to a special enrollment period for these patients this year and to take action to prevent similar, misleading marketing practices in future years. The letter also was accompanied by a compilation of problems patients and pharmacists are experiencing.

“NCPA previously warned that these overly restrictive Medicare drug plans were being deceptively marketed to patients and lack adequate pharmacy access for Americans in rural or underserved areas. While not surprising, it is unfortunate that our concerns were validated within the first few days of the 2012 plan year,” NCPA CEO B. Douglas Hoey said. “Now, seniors are going to the community pharmacy that they have relied on for years, sometimes decades, only to be told that they must travel 20 miles or more to obtain the lowest-advertised co-payments for their medication.

“While CMS is working with us to address individual patient concerns, we believe as a matter of fairness that all enrollees in these restrictive network plans should have the chance to reevaluate whether this is the right plan for them,” Hoey added. “Every day about 10,000 Americans turn 65 and are eligible to enroll in a Medicare drug plan. Medicare should allow seniors who feel that they’ve been duped the same choice as those just entering the program. In addition, CMS should implement preventative steps to avoid a repeat of this situation next year.”

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