Medicare Part D: The first 12 days | NCPA Executive Update | January 12, 2024

NCPA January 12, 2024

Dear Colleague,

Doug Hoey The highest ranking pharmacist ever serving in the U.S. government was Vice President Hubert Humphrey. One of his famous quotes had this to say about the elderly and others: "The moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; those who are in the shadows of life, the sick, the needy and the handicapped."

Humphrey wasn't alive when Medicare Part D was created but he might take issue with some of what NCPA members are reporting to us in 2024. The industry has known about the potential for a "DIR Hangover" ever since CMS finally passed regulations that largely eliminated pharmacy DIR that had grown by 117,000 percent over a decade—an unsustainable pace that was choking community pharmacies and overcharging beneficiaries. NCPA has been sounding a cautionary alarm to pharmacies for over a year to help them prepare for if (or when) the DIR Hangover hit.

We have continued to be in regular communications with CMS about what we are hearing, and they have provided an email address to hear from pharmacies: [email protected].

NCPA asked CMS what information would be most helpful for them to hear about and this is what they recommend:

  1. Pharmacy access challenges: Inform CMS about underserved communities in your area lacking pharmacies, or in-network pharmacies

    a. Consider including information about your pharmacy's location (ex. Are you located in a rural area? How far is the nearest pharmacy? Have nearby pharmacies closed recently, either permanently or temporarily?)

    b. Consider including information about pharmacy closures near you in the past 3-6 months

    • Patient harm/confusion/steering: Has a PBM practice negatively impacted your patients' care?

    • PBM network misrepresentation: Have you encountered inaccuracies or misleading information about your pharmacy's network participation or capabilities?

    • Percentage of Medicare population served: Knowing the scope of your Medicare patient base helps analyze the impact of PBM policies on vulnerable populations.

    Note that CMS is not asking about pharmacies being paid below their cost. Remember CMS' charge is to ensure that beneficiaries have access to prescription drugs in the Part D program. They do not focus on the economics for the pharmacy. Make your comments to CMS count by focusing on beneficiary access or compromised patient care. Direct your submissions to [email protected] and cc NCPA at: [email protected].

    That doesn't mean no one cares about pharmacy economics because, obviously, if the economics don't work, the pharmacy can't stay in business and beneficiary access is lost. While this is only the 12th day of the new year, NCPA is hearing from several members about unsustainably low reimbursement, interestingly, often associated with generic drugs. NCPA is already working diligently to assess the financial impact of Part D 2024 on some pharmacies and is in dialogue with CMS regarding potential PBM noncompliance with the DIR rule.

    Send your comments to CMS but make them count by focusing on CMS' charge to take care of beneficiaries.

    And don't be shy about reminding your senior patients to call 1-800-MEDICARE (800-633-4227) or do a Live Chat at Hearing from beneficiaries is still the most effective way to get CMS' attention.


    Doug Hoey

    B. Douglas Hoey, Pharmacist, MBA