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Independent Pharmacists Raise Concerns Over Letters From CVS Caremark Indicating Members Must Pay Higher Copayments At Non-CVS Pharmacies
Posted by: admin in Pharmacy Drugs on November 17th, 2009
An unidentified trade group representing independent pharmacies on Wednesday plans to send to Federal Trade Commission Chair Jon Leibowitz a series of letters from pharmacy benefits manager CVS Caremark that indicate the PBM charges higher copayment rates for some of its members who opt to fill their prescriptions at pharmacies other than CVS, the Wall Street Journal reports. The letters, which were obtained and reviewed by the Journal, were sent by CVS Caremark to its members as recently as February.
According to the Journal, the patients were enrolled in CVS’ “Maintenance Choice” program, which allows them to fill 90-day prescriptions through the company’s mail-order pharmacy or pick them up directly from a drugstore at no additional cost. The Journal reports that some of the letters indicated that copays for patients who filled prescriptions at non-CVS pharmacies would increase to 50% of the price on their prescriptions, instead of the 25% of the cost of the drugs they would be charged at a CVS pharmacy.
Another letter sent to a beneficiary stated that “no additional fills of your prescriptions will be covered” at a non-CVS pharmacy, despite the treatment being covered under the patient’s plan. A third letter obtained by the Journal explained that when the Medicare patient in January filled a prescription for a 30-day supply of a generic cholesterol drug at a non-CVS pharmacy, Medicare did not pay anything while the beneficiary paid $4.70. However, when the patient filled a 90-day supply of the same drug at a CVS pharmacy in March, Medicare had to pay $165.99 while the patient made a $15 copay.
According to the Journal, some independent pharmacies raised concerns in 2007 when FTC approved the merger between CVS and Caremark that the $27 billion deal would have a negative impact on their business. The Journal reports that independent pharmacists say that prior to the merger, CVS vowed not to discriminate against them.
CVS in a statement said, “In general it is not uncommon to have some variation in pharmacy-reimbursement rates and prescription prices within retail pharmacy networks administered by PBMs.” The company added that its Maintenance Choice program is “consumer friendly,” but did not explicitly address the letters or the claims made by the independent pharmacists, the Journal reports (Martinez/Armstrong, Wall Street Journal, 5/13).
Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.
© 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
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