Reps. Collins and Carter to CMS: Protect Community Pharmacies

June 28, 2016

Washington, D.C. – Today, Congressmen Doug Collins and Buddy Carter sent a letter to Center for Medicare and Medicaid Services Acting Administrator Andy Slavitt asking for a review of Humana’s proposed amendments to its Pharmacy Provider Agreement for the 2017 Part D plan year. The amendments will force independent community pharmacies to accept predatory pricing provisions that could severely impact their ability to do business. Congressmen Collins and Carter, who have been strong advocates for community pharmacies, issued the following statements after sending the letter:

“In many rural parts of the country, including Northeast Georgia, folks may see their pharmacist more often than they see their doctor,” said Congressman Collins. Pharmacists, especially those from independent pharmacies, have an established connection with those they serve in the community, and take great care when advising their patients. Many of these establishments are family-run and have been part of these communities for years.”

“Humana, one of the largest insurance providers in the country, currently has a proposal the would require these small pharmacies to lose $5.00 per prescription, up front, with the hope that they will be reimbursed if they meet certain metrics. However, meeting all of the criteria is not a guarantee that the pharmacy will get reimbursed because there are only spots in the top rankings for a few pharmacies. Under this proposal, a pharmacy could meet most of the CMS benchmarks, provide quality customer care, and still not be reimbursed by Humana. Humana’s criteria has little to do with patient care, and everything to do increasing their profit and driving community pharmacies out of the market. Some of these metrics, including “patient adherence” are beyond the control of the pharmacists. Pharmacies already compete for customers and business, let’s not set a precedent to make them compete for reimbursement by insurance companies as well.”

“Humana is using this proposal to attempt to drive community pharmacies out of the marketplace, to clear the way for big box chain pharmacies like Walgreens and CVS. If this proposal is allowed by CMS and enacted, these community pharmacies will either have to pay huge sums of money with no guarantee they will be able to recover their costs, or become out of network providers, which will increase costs and drive patients away. Improper metrics are being used to determine the future existence of community pharmacies in this situation, and deserve further examination from CMS.”

“As a community pharmacist for more than 30 years, I know firsthand how hard it is for the smaller guys to stay competitive, especially in the face of predatory pricing,” said Congressman Carter. It is unsustainable and unacceptable for one of the largest insurance providers in the country to force small pharmacies to lose money upfront with an uncertainty on whether or not they will even be reimbursed. This proposal would allow Humana to not reimburse pharmacies even if they meet most of the CMS benchmarks.

“I’m a free-market guy. We need to let the free-market work. This proposal does nothing more than infringe on the free-market in pharmacy, increase Humana’s profits and actively work to drive community pharmacies out of the market. If allowed, this proposal will leave community pharmacists with two choices: leave themselves vulnerable to the very real possibility they will not be reimbursed or become an out of network provider which will increase costs for patients. My patients were always like family members and they should have the ability to choose whatever pharmacy is best for them and their health. I strongly urge Acting CMS Administrator Slavitt to reconsider this adverse proposal.”