Feds: Medicare enrollees in urban areas to see improved access to prescription savings

Medicare beneficiaries who live in urban areas may save money on their prescription drugs this year because they have better access to pharmacies in drug plan networks that charge lower copayments or coinsurance, new federal analysis has found (Source: “Urban Medicare Beneficiaries May See More Drug Savings This Year,” Kaiser Health News, Feb. 19, 2016).

According to Centers for Medicare & Medicaid Services analysis, “preferred cost-sharing pharmacies” have been on the rise. In 2016, 85 percent of standalone Medicare drug plans identified a subset of pharmacies that offered lower or “preferred” cost sharing within their pharmacy networks, as did 28 percent of Medicare Advantage drug plans. In 2014, the figures were 70 percent and 15 percent, respectively, CMS said.

When CMS analyzed the plans that were offered in 2014, it found that while overall most beneficiaries had convenient access to a preferred cost-sharing pharmacy, urban beneficiaries’ access was spottier. On average, 79 percent lived within two miles of a preferred cost-sharing pharmacy, the distance considered convenient in a city. In contrast, 94 percent of suburban beneficiaries lived within five miles of a preferred cost-sharing pharmacy, on average, and an average 88 percent of rural beneficiaries lived within 15 miles of such a pharmacy, reflecting the benchmarks for convenient access in those areas based on population density.

Since then, CMS has worked with drug plans to improve access to in-network pharmacies that offer preferred cost-sharing.  According to CMS, the drug plans that provided the worst access to preferred cost-sharing pharmacies for urban beneficiaries in 2014 did better this year. Specifically, an analysis of the bottom 10 percent of plans found that while 40 percent of urban Medicare beneficiaries in 2014 had convenient access to preferred cost-sharing pharmacies, that figure nearly doubled to 71 percent in 2016.