WASHINGTON, March
11, 2014 /PRNewswire-USNewswire/ -- A new actuarial study released by The Pharmaceutical Care Management
Association (PCMA) examining the impact proposed changes to the
Medicare prescription drug program finds that eliminating preferred pharmacy
networks in Part D would increase premiums by
approximately $63 annually for over 75 percent of Part D enrollees
and raise overall program costs by an estimated $24 billion over the
next ten years.
"CMS' proposal
to eliminate preferred pharmacy networks will make it harder and more expensive
for seniors to access prescription drugs," said PCMA President and CEO Mark Merritt.
The study examines
the sections of CMS' proposed rule on preferred pharmacy networks. Currently,
more than 75 percent of Part D beneficiaries are enrolled in plans that feature
preferred pharmacy networks.
Key findings from
the study, which was sponsored by PCMA and prepared by Oliver Wyman,
include:
- As of February 2014, more than
75% of prescription drug plans (PDP) enrollees are in plans with preferred
pharmacy networks and these enrollees could be adversely affected by the
elimination of plans utilizing preferred pharmacy networks.
- The preferred pharmacy networks
provision would increase premiums for the affected population by an
average of approximately $63 per year for the 2015 plan year.
- The rule could increase cost sharing
among PDP enrollees by an average of $80 to $100 per
year.
- Since the rule would inflate the
national average benchmark for Part D plans, CMS would pay an estimated
additional $64 in direct subsidies per beneficiary per year in
2015, for a total increased payment of nearly $1.5 billion in
2015 across all PDP enrollees, based on Part D enrollment of approximately
23 million beneficiaries.
- Over a 10-year period, the increased
cost of eliminating preferred pharmacy networks is estimated to be
approximately $990 per affected enrollee, and the cost would be
approximately $24 billion to CMS in the form of higher direct
subsidy payments.
Oliver
Wyman's findings are generally consistent with a separate Milliman analysis that found the entirety of the
proposed rule will increase Part D costs by up to $1.6 billion in
2015.
In addition, a
recent poll found that seniors in plans with preferred pharmacy networks are
overwhelmingly satisfied, citing lower costs, convenient access to pharmacies
and other benefits, according to a survey from Hart Research Associates. The
survey found that 85 percent of seniors surveyed are satisfied with their
preferred network plan. In addition, the survey found that four in five seniors
would be disappointed if their preferred network plan is eliminated.
The Medicare
Payment Advisory Committee has warned CMS that the proposed changes to
preferred pharmacy networks could lead to disruptions in beneficiaries' access
to medicines.
PCMA represents the
nation's pharmacy benefit managers (PBMs), which improve affordability
and quality of care through the use of electronic prescribing
(e-prescribing), generic alternatives, mail-service pharmacies, and other
innovative tools for 216 million Americans.
