SCPC Questions Applicability of Proposed Medicare Part D “Lock-in” Provision to Long Term Care Pharmacies, Patients

Senior Care Pharmacy Coalition (SCPC) Stresses Sharp Difference Between Retail, LTC Pharmacies

Washington, DC – In joining the American Medical Association (AMA) and others in raising practical concerns about a proposed Medicare Part D pharmacy “lock-in” provision contained in the House Energy and Commerce Committee’s draft “21st Century Cures” legislation, the Senior Care Pharmacy Coalition (SCPC) today stressed the sharp difference between retail and independent long term care (LTC) pharmacies. Moreover, the group respectfully questioned the provision’s inherent applicability to LTC pharmacies and their patients in the context of controlling frequently abused controlled substances.

The SCPC represents companies that own and operate independent long-term care (LTC) pharmacies in roughly 40 states, serving over 325,000 SNF and ALF residents, generating combined annual revenues of more than $1.7 billion.

“Among the primary reasons SCPC was founded is because of the significant need to educate lawmakers, regulators and the broader health policy community about the specific nature of LTC pharmacies and their patients in general, and the significant difference between LTC pharmacies and retail pharmacies in particular,” stated Alan G. Rosenbloom, President and CEO of SCPC. “Such is clearly the case regarding the ‘lock-in’ concept itself contained in the draft ‘21st Century Cures’ legislation. Stringent safeguards already exist when it comes to LTC pharmacies’ oversight of controlled substances while serving the needs of skilled nursing facility (SNF) and Assisted Living Facility (ALF) patients.”

Rosenbloom said SCPC’s recently submitted comments to House Energy and Commerce Chairman Fred Upton (R-MI) regarding the draft 21st Century Cures legislation further detail the SCPC’s concerns:

“The PDP Drug Safety Program established in section 4281 of the Committee’s draft should be modified to accommodate the specialized capacity of LTC pharmacies to avoid abuse of controlled substances while serving the needs of SNF and ALF residents. LTC pharmacies already provide greater oversight of prescription dispensing and usage than the provisions of section 4281 require. In addition, due to substantial differences between retail and LTC pharmacies, the provision as drafted would pose significant quality of care and compliance issues for LTC facilities and would undermine Medicare beneficiary choice in selecting LTC facilities.”

SCPC’s comments also focused on patient access and choice:

“The SCPC is also concerned that the provision could limit patient choice improperly. Patients choose a SNF or ALF for many reasons. However, it is their choice, not the choice of a PDP, and it is never based upon whether a particular LTC pharmacy contracts with a particular SNF or ALF. Under the draft legislation, once a PDP chooses the members of its safe pharmacy network, it essentially dictates the beneficiary’s choice of LTC facility if the beneficiary is required to participate in a safe pharmacy network.”

Rosenbloom concludes, “The SCPC would welcome the opportunity to work with Committee staff to address these concerns. One potential solution might be to exempt either LTC pharmacies or Part D beneficiaries receiving care and services in LTC settings, and believe there are administratively simple ways to implement such a provision.”

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