On Tuesday, NCPA CEO Douglas Hoey sharply implored CMS to evaluate ESI Part D contract terms that are leading to pharmacy closures and, importantly, dire consequences for patients. “Pharmacy owner members frequently cite Cigna-ESI’s draconian contract terms—particularly on brand name prescriptions—when talking about whether they will be able to keep their business open,” said Hoey. He cited recent NCPA survey data that shows 32 percent of pharmacist respondents are considering closing their doors in 2024 because of the Medicare cash crunch and 93 percent said they might drop out of Medicare Part D in 2025 if this year doesn’t turn around for them. The letter also highlights our concerns with per-claim ESI bonus pool payments that are not transparent at point-of-sale and only assessed in aggregate on the remittance advice.
“If CMS does not take immediate action, how will CMS know what ESI is doing with the money they are collecting and how will the ‘promise’ that all funds will be redistributed to certain pharmacies be audited by CMS?” Read the letter here. On April 15, NCPA blasted ESI for its lack of forward momentum on revising contracts that would align with its obligation to offer “reasonable and relevant” terms for participation in the Medicare Part D pharmacy network and, importantly, to revise its “bonus pool fee” to align with federal policy.
