Dive Brief:
- The plan Medicare set up to create affordable drug plans for seniors is coming under scrutiny again, as CMS has discovered that there are still some instances in which it doesn't work the way it's supposed to, according to a report in Healthcare Payer News.
- At issue is the availability of preferred cost-sharing pharmacies, which were a centerpiece for the Medicare Advantage program. According to the report, a number of independent pharmacies have contacted CMS to complain about Part D plans not providing adequate access to in-network preferred cost-sharing pharmacies. The standard for urban areas, which often isn't met, is for 90% of patients to be within 2 miles of a preferred cost sharing pharmacy.
- "CMS will continue to monitor access levels to PCSPs subsequent to the bidding process, and we may consider broadening our outlier review to include additional plans in the future," the agency wrote, according to the report.
Dive Insight:
From the research, its seems that problems with Medicare Advantage aren't what CMS leaders expected. Rural patients, whose ability to access care was in question, seem to be receiving excellent access under the program. Meanwhile, those who live in large cities seem to be getting the shaft from their Part D plans.