January 16, 2018
Via Electronic Submission
The Honorable Seema Verma, M.P.H.
Administrator Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attn: CMS-4182-P 7500 Security Boulevard Baltimore, MD 21244
Dear Administrator Verma:
The Senior Care Pharmacy Coalition (SCPC) appreciates the opportunity to comment on the proposed rule entitled “Medicare Program: Contract Year 2019 Policy and Technical Changes to the Medicare Advantage, Medicare Cost Plan, Medicare Fee-for-Service, the Medicare Prescription Drug Benefit Programs, and the PACE Program,” (CMS-4182-P; RIN 0938-AT08, 82 Fed. Reg. 56336 (November 28, 2017)) (“the Proposed Rule”), and particularly the Medicare Prescription Drug Benefit (or Part D) proposals in the rulemaking. The Proposed Rule includes several proposals affecting beneficiary access to medications under the program and the ability of long-term care (LTC) pharmacies to dispense those medications and provide related consultative services. We appreciate the opportunity to share our comments with the agency to improve and refine the proposed regulatory changes.
SCPC is the only Washington-based organization exclusively representing the interests of LTC pharmacies. SCPC represents 75% of all independent LTC pharmacies and our members serve about 700,000 residents daily in skilling nursing and assisted living facilities across the country.1 As such, we have a unique perspective into the proposed rule from the LTC pharmacy perspective, which we share below.
SCPC has divided its comments into two sections. In section I we provide key background information concerning the LTC pharmacy and the pharmacy benefit manager (PBM) markets, each of which is essential to understanding the often-unique implications of Prescription Drug Plan (PDP)/PBM pricing and practices relevant to the Proposed Rule. In Section II, we offer detailed comments concerning nine aspects of the Proposed Rule. SCPC commends and strongly supports many proposed provisions, but also believes CMS should reject or revise other provisions and should add provisions to achieve the objectives the agency seeks to achieve. We specifically comment on the following issues:
1. Implementing the opioid and “frequently abused drug” provisions of the Comprehensive Addiction and Recovery Act of 2016 (CARA);
2. Improving the “any willing pharmacy” regulation;
3. Addressing improper PBM and PDP “pharmacy payment adjustments;”
4. Modifying the LTC transition fill requirements from 90 to 30 days;
5. Permitting mid-year formulary substitutions of generic for brand medications;
6. Implementing electronic prescribing standards;
7. Limiting Part D Beneficiary Special Enrollment Periods;
8. Permitting medication therapy management (MTM) to count towards MLR calculations; and
9. Addressing physician NPI requirements and adding “preclusion” list requirements.