On Monday, President Trump met with insurance companies to create a joint effort among Medicare and Medicaid to help prevent the spread of COVID-19. Shortly thereafter, Administrator Seema Verma mentioned release of a Centers for Medicare & Medicaid Services guidance outlining the flexibilities Medicare Advantage and Part D plans have to waive certain requirements to help combat the disease. These flexibilities include:
- Waiving cost-sharing for COVID-19 tests.
- Waiving cost-sharing for COVID-19 treatments in doctors’ offices or emergency rooms and services delivered via telehealth.
- Removing prior authorizations requirements.
- Waiving prescription refill limits.
- Relaxing restrictions on home or mail delivery of prescription drugs for retail pharmacies.
- Expanding access to certain telehealth services.
To ensure pharmacy access during a disaster or state of emergency resulting from COVID-19, CMS includes flexibilities for retail pharmacies regarding mail and home delivery of prescription drugs: “In situations when a disaster or emergency makes it difficult for enrollees to get to a retail pharmacy, or enrollees are actually prohibited from going to a retail pharmacy (e.g., in a quarantine situation), Part D sponsors are permitted to voluntarily relax any plan-imposed policies that may discourage certain methods of delivery, such as mail or home delivery, for retail pharmacies that choose to offer these delivery services in these instances.” In addition, CMS directs Part D sponsors to ensure enrollees have adequate access to Part D drugs dispensed at out-of-network pharmacies; enrollees would be responsible for any cost sharing under their plan.
NCPA supports urging CMS to require, rather than allow, Part D sponsors to relax any restrictions on retail pharmacies that would discourage them from offering mail or home delivery services, and suspend any conflicting contract language that may interfere with these relaxed requirements on retail pharmacies. NCPA encourages community pharmacies to work with their plan sponsors to explore participating in mail or home delivery services in light of this CMS guidance.
