Pharmacy group wants SNF and AL beneficiaries exempted from Part D ‘lock-in’ provision

DATE: May 14, 2015

The head of a new long-term care pharmacy advocacy group urged Congress on Thursday to exempt Medicare beneficiaries in nursing homes and assisted living facilities from a plan that would require them to use a single pharmacy for all medications.

The provision at issue is called the “lock-in” clause in pending legislation based on the sweeping “Path to 21st Century Cures” initiated last year under the Obama administration. The provision would require Part D beneficiaries to use (or be locked into) the same pharmacy for all prescriptions as a means for curbing substance abuse.

In a public statement, Alan G. Rosenbloom, president of the independent Senior Care Pharmacy Coalition, argued that current language in the legislation opens the door for “protecting” beneficiaries from such restrictions.

“The SCPC supports the Committee’s dedication to preventing prescription drug abuse among seniors,” Rosenbloom stated. “We urge Congress, if it proceeds with programs to prevent drug abuse under Medicare, to recognize that these settings should be exempt from the ‘lock-in’ provision.”

Rosenbloom, who previously presided over the former Alliance for Quality Nursing Home Care, argued that beneficiaries in skilled nursing facilities and other long-term care settings such as assisted living “already have sufficient protections and should be exempted.”

The American Pharmacists’ Association has also taken issue with the clause, calling it “somewhat out of step with the broader aims of the legislation” because it includes all Part D drugs and not exclusively opioids, which are the major culprits of abuse, as well as provides plans with unilateral authority to suspend pharmacy claim payments indefinitely based on unsubstantiated fraud allegations.

The House Energy and Commerce Committee last January released its first draft of legislation tentatively titled the “21st Century Cures Act,” which would streamline the process of drug development and overhaul the way the FDA regulates many healthcare products.

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