Proposed Medicare Part D “Lock-in” Provision Problematic For Long Term Care Pharmacies, Patients

Senior Care Pharmacy Coalition (SCPC) Proposes Legislative Path to Retaining Seniors’ Access to Needed Medications in Long Term Care Facilities

In a statement submitted for the record for today’s House Energy and Commerce Health Subcommittee hearing on pending “21st Century Cures” legislation, the Senior Care Pharmacy Coalition (SCPC) said a proposed Medicare Part D “lock-in” provision contained in the new draft bill could inadvertently restrict seniors’ access to needed medications in skilled nursing facilities and other long term care facilities. Included in the bill to help reduce prescription drug abuse among Prescription Drug Plan (PDP) Part D beneficiaries, SCPC maintains the provision’s objective, while laudable, is problematic to Part D beneficiaries in long term care (LTC) facilities because these facilities and pharmacies must already satisfy more stringent safeguards than the legislation would establish.

The SCPC represents companies that own and operate independent LTC pharmacies in more than 40 states, serving over 350,000 patients in skilled nursing facilities (SNFs) and assisted living facilities (ALFs) every day.

“The SCPC supports the Committee’s goals of improving Medicare Part D through fraud and abuse prevention efforts, and of reducing prescription drug abuse and diversion among Part D beneficiaries,” stated SCPC President and CEO, Alan G. Rosenbloom. “However, we are concerned that the PDP Drug Safety Program established in section 3151 of the bill does not recognize the specialized capacity of LTC pharmacies to prevent potential abuse of controlled substances.”

Rosenbloom said that due to the substantial differences between retail and LTC pharmacies, the provision as drafted would pose significant quality of care and compliance issues for both LTC pharmacies and LTC facilities, particularly SNFs. “More importantly, section 3151 inadvertently could prevent or delay patient access to needed medications, and could undermine Medicare beneficiary choice in selection of a LTC facility.“

In the statement, Rosenbloom notes LTC pharmacies already provide greater oversight of prescription drug dispensing and usage than section 3151 would require, and are in a unique position to ensure the integrity of the Part D program. “As contracted pharmacies servicing LTC facilities, our members’ pharmacists already have oversight of patients’ entire drug regimens. The statutory and regulatory requirements imposed by Medicare on LTC pharmacies – as well as the methods of packaging, dispensing, and tracking medications and monitoring usage in LTC facilities – mean that LTC pharmacies already satisfy higher standards than those section 3151 would impose on pharmacies in any safe pharmacy network.”

These requirements include, but are not limited to:

  • Extensive pharmacy operations and prescription services;
  • Around-the-clock delivery;
  • 24-hour on-call pharmacists, including many pharmacies that open and staffed 24 hours a day, seven days a week;
  • Emergency medications;
  • Specialized packaging;
  • Comprehensive inventory;
  • Capacity to comply with the reporting requirements necessary to provide these services.

In addition, Rosenbloom noted, Medicare and Medicaid Conditions of Participation for LTC facilities require that the pharmacy provide oversight and management of all medications for each patient receiving care and services in the facility.

Of particular note with respect to narcotics:

  • LTC pharmacists and licensed LTC facility staff use count sheets to track every dose of narcotics prescribed and administered;
  • LTC pharmacists and licensed LTC facility staff conduct regular narcotic audits to ensure compliance;
  • Orders and reorders of narcotics are handled by LTC pharmacists and licensed facility staff — not the Medicare beneficiaries themselves.

Proposed SCPC Solution: The final bill should clarify that certain individual Part D beneficiaries residing in settings in which pharmacy access is already highly controlled are exempt from the requirements of the provision, thus ensuring that residents of LTC facilities and other closed pharmacy settings can continue receiving medications in the existing highly controlled structure that already exists.

The Bottom Line: “SCPC’s desired clarification will ensure that Part D beneficiaries in LTC facilities are not inadvertently prohibited from access to needed medications when they transition into or out of the LTC facility or reside there,” Rosenbloom concluded. “This simple, no-cost, and noncontroversial clarification would ensure that LTC facility residents, who are already well protected from prescription drug abuse, are not adversely affected by the provision.