Community pharmacies provide cost-saving medication and pharmacy services to millions of Medicare Part B and D patients. Congress and the Centers for Medicare and Medicaid Services (CMS) are making changes to the program all the time. This section lists important changes that community pharmacists should know.
As Medicare beneficiaries review their 2021 Medicare Part D choices, you are sure to get an abundance of questions, so be prepared.
Ensuring Seniors Access to Local Pharmacies Act – H.R. 4946
Medicare beneficiary access to prescription drugs is impeded by mandates from insurance middlemen (pharmacy benefit managers or PBMs) that effectively dictate which pharmacy to use based on exclusionary “preferred pharmacy” arrangements between PBMs and, often, Big Box or mail order pharmacies. Independent community pharmacies are not allowed to participate in some of these arrangements, even if they offer to accept the Part D plan’s same contract terms and conditions. This can raise access issues for patients in underserved and rural areas in which independent community pharmacies are predominantly located, which means seniors in these communities often face either higher copays or trips of 20 miles or more to a "preferred" pharmacy .