CMS Says It Won't Move Forward With Several Provisions of Part D Proposal

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By Bronwyn Mixter  

March 10 --Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner told Congress March 10 that the CMS won't move forward with four provisions of a controversial proposed rule governing Medicare's prescription drug program.

Tavenner in a letter said the CMS has decided not to finalize the Medicare Part D proposals relating to the “protected classes” definition on three drug classes, standards for preferred pharmacy networks, the number of Part D plans sponsors may offer and clarifications to the noninterference provision.

“Given the complexities of these issues and stakeholder input, we do not plan to finalize these proposals at this time,” Tavenner said. “We will engage in further stakeholder input before advancing some or all of the changes in these areas in future years.”

She said the CMS does plan to finalize proposals related to consumer protections, anti-fraud provisions and transparency.

Criticism of Proposed Rule

On March 7, House Energy and Commerce Committee Republicans wrote Tavenner, calling on the administration to rescind the proposed rule, saying it might cause millions of seniors to lose their plans and force millions of seniors to pay more for their prescription drugs.


“The Administration's decision not to finalize the most controversial proposals in the Part D proposed regulation shows they have listened to stakeholder comments,” Rep. Sander Levin said.  

 


The committee members said that if the administration didn't act, the House would move legislation on the matter this week.

On March 6, Rep. Renee Ellmers (R-N.C.) introduced H.R. 4160, the Keep the Promise to Seniors Act. The legislation would protect and preserve the integrity of the Medicare Part D prescription drug program and prevent the administration from making the proposed changes, according to a press release on the bill.

“The Administration's decision not to finalize the most controversial proposals in the Part D proposed regulation shows they have listened to stakeholder comments,” Rep. Sander Levin (D-Mich.) said in a statement on the letter from Tavenner. Referring to H.R. 4160, Levin said, “This further highlights that the House Republican bill scheduled for a vote Tuesday that would prohibit the agency from implementing any part of the regulation would undermine clearly helpful beneficiary and anti-fraud protections and would be a gross overreach, undermining the regulatory process. Republicans should withdraw this bill.”

Levin is the ranking member on the House Ways and Means Committee.

Rep. Dave Camp (R-Mich.), chairman of the House Ways and Means Committee, said in a statement that he appreciates “that CMS Administrator Marilyn Tavenner will not finalize controversial provisions of the proposed Part D rule.”

“It was clear from the overwhelming number of comments from seniors, advocacy groups, Part D plans and Members of Congress that CMS' proposal would significantly alter the Part D program and could put in jeopardy seniors' access to affordable medications,” Camp said. “While this announcement provides limited relief in the short-term, it should lay the groundwork for strong bipartisan support for legislation expressing Congress' disapproval of these proposals. As Part D approaches a decade of providing access to affordable prescriptions for seniors, Congress must redouble its efforts to work with all parties to ensure the long-term viability of the successful Part D program.”

Support for CMS Decision

The Healthcare Leadership Council (HLC) March 10 commended the leadership of the CMS for its decision to refrain from moving forward with certain provisions of the proposed rule.

“We applaud CMS Administrator Tavenner for the agency's sound judgment on this issue,” HLC President Mary R. Grealy said in a statement. “It became clear in recent weeks that there were deep concerns among seniors, patient organizations and healthcare providers about the effect these changes would have on one of the federal government's most successful programs. The health and lives of millions of Medicare beneficiaries have been strengthened by Part D's accessible, affordable drug coverage, and the qualities that have made this program so effective need to be preserved.”

HLC initiated a March 3 letter to the CMS urging withdrawal of the proposed rule, which was signed by 371 organizations .

“We agree with Administrator Tavenner that there needs to be a continuing dialogue among stakeholders to make certain we're taking the right steps to protect the health of current and future Medicare beneficiaries,” Grealy said. “We look forward to working with her and her leadership team at CMS to continue improving a program that is already fulfilling its public mission extraordinarily well.”

PCMA Study

Meanwhile, the Pharmaceutical Care Management Association (PCMA) March 10 released a study examining the impact of the proposed rule.

The study said that eliminating preferred pharmacy networks in Part D would increase premiums by approximately $63 annually for more than 75 percent of Part D enrollees and raise overall program costs by an estimated $24 billion over the next 10 years.

“CMS' proposal to eliminate preferred pharmacy networks will make it harder and more expensive for seniors to access prescription drugs,” Mark Merritt, president and chief executive officer of PCMA, said in a statement. The PCMA represents pharmacy benefit managers.

Merritt also said in a separate March 10 statement on Tavenner's letter that the “CMS was wise to reconsider its proposed Part D rule that would have destabilized the program, increased costs, and disrupted coverage for millions of seniors.”

“While we welcome this temporary reprieve, we still await the final rule,” Merritt said. “However, today's announcement appears to be a step in the right direction for Medicare Part D beneficiaries.”

Pharmacist Group Weighs In

B. Douglas Hoey, chief executive officer of the National Community Pharmacists Association (NCPA), said in a statement that NCPA is “deeply disappointed in CMS' decision not to move forward at this time with the pharmacy choice provision included in its proposed rule.”

“CMS has heard repeatedly from community pharmacists and patients regarding the inadequacies of 'preferred pharmacy' drug plans. They have been deceptively marketed and are confusing to patients.” Hoey said. “In many rural communities, independent community pharmacies are the only pharmacy provider and they are often excluded from preferred pharmacy arrangements--financially penalizing these seniors or forcing them to travel 20 miles or more to reach a preferred pharmacy. In addition, many underserved populations rely on the personalized service of independent pharmacies and going to a 'preferred' pharmacy is a burden.”

Hoey said the CMS “has a legal obligation to uphold the Social Security Act and CMS itself acknowledged that preferred pharmacy plans often raise costs to Medicare and the taxpayer, which is a violation of that statute.”

“We implore CMS to revisit this topic in the near future,” Hoey said. “We encourage CMS to move forward with other key provisions in the rule, including expanding medication therapy management (MTM) eligibility; giving more seniors the same co-pay, in certain instances, whether they use a community pharmacy or mail order; allowing CMS to require plan sponsors to hire independent auditors; banning reimbursement practices that penalize long-term care pharmacies for adopting cost-efficient dispensing practices; and protecting seniors by establishing fulfillment requirements for mail order pharmacies, in response to a litany of complaints.”

Hoey said NCPA and its members will continue to work with federal and state policy makers regarding these issues.

 

To contact the reporter on this story: Bronwyn Mixter in Washington at bmixter@bna.com

To contact the editor responsible for this story: Janey Cohen at jcohen@bna.com