When you think of Congress and health care, the debate surrounding the Affordable Care Act (or “Obamacare”) may come to mind, but there are other important health care issues that should not go unnoticed by the public and Congress. One such issue is a proposal to give seniors access to discounted prescription drug copays at more pharmacies and it is worthy of Congressional support. The Medicare drug plan benefit, also known as Part D, has facilitated insurance coverage for prescription drugs for millions of seniors. However, currently some drug plans are forcing beneficiaries to either leave the pharmacy of their choice or pay higher out-of-pocket costs. Texas-owned pharmacies are usually left out of these exclusive arrangements whereby health insurance middlemen designate so-called “preferred” pharmacies, such as the big chains. Moreover, local pharmacies are still excluded even when they offer to accept the same contractual terms and conditions as the plan’s “preferred” pharmacy. For many rural residents, their closest pharmacy may be an independent pharmacy that has been rebuffed by the plan. This could mean traveling a great distance, in some cases 20 miles or more to reach a preferred pharmacy or paying more out of pocket to choose a more convenient location. For example, according to Medicare’s plan finder, under the Humana Enhanced and the Humana Preferred Rx plans, there are no preferred pharmacies within three miles of Pilot Point, Texas and only one of the 12 pharmacies within 14 miles is preferred. This is also a problem in urban areas particularly for seniors who lack reliable transportation where even traveling a couple miles is a heavy burden.
Fortunately, a common-sense solution has been introduced in Congress to expand seniors’ access to discounted (or preferred) copays. H.R. 4577, the Ensuring Seniors Access to Local Pharmacies Act is bipartisan legislation introduced by Congressmen Morgan Griffith (R-Virginia) and Peter Welch (D-Vermont). It has earned the support of 58 additional Congressional cosponsors from across the political spectrum and enjoys support from local organizations such as the Texas Pharmacy Association and others. Moreover, the legislation is supported by consumers. Organizations such as the Medicare Rights Center, National Rural Health Association, National Grange and Consumers Union have all voiced support for H.R. 4577.
A recent survey by the polling firm Penn, Schoen and Berland found 76 percent of likely voters support this legislation, Republicans, Democrats and Independents alike. If enacted, the bill would allow any pharmacy located in a medically underserved area the opportunity to participate as a preferred pharmacy and offer the same out-of-pocket costs to beneficiaries so long as the pharmacy accepted the plan’s terms and conditions. Increased pharmacy access also has the benefit of promoting medication adherence, or properly taking medication as prescribed. Non-adherence costs the health care system as much as $290 billion each year by necessitating medical procedures which could have been prevented if the patient had properly taken their medication. Factors that lead to non-adherence such as language barriers, distance or cost are mitigated when patients are free to choose the pharmacy that best suits their individual needs. In addition, the Centers for Medicare and Medicaid Services (CMS) – the agency that runs Medicare – has stated that allowing any pharmacy willing to accept the contractual obligations the opportunity to participate as a preferred pharmacy is the best way to promote competition and lower costs in the Part D program.
H.R 4577 addresses pharmacy access concerns in our most vulnerable areas, ones which are defined as medically underserved or suffering from a shortage of health care professionals. Many of my fellow pharmacists are ready and willing to accept the terms and conditions of prescription plans if given the opportunity to do so. I urge every member of the Texas Congressional delegation to cosponsor H.R. 4577, particularly Representatives Joe Barton, Michael Burgess and Gene Green. They are members of the House Energy and Commerce Committee which has extensive jurisdiction over the bill. I also want to recognize and applaud Reps. Pete Olson, Ruben Hinojosa and Pete Gallego, all of whom have already signed on to cosponsor H.R. 4577. Working together we can give Medicare beneficiaries and their caregivers more choice while allowing Texas-owned small business pharmacies a better shot to compete.
Harmison is owner of Harmison Pharmacies L.C. in Arlington and is a past president of the National Community Pharmacists Association. www.ncpanet.org