Rising Part D Drug Prices Adversely Affect Physicians, Patients

AAFP Presses CMS to Find Solutions

April 15, 2016 02:33 pm News Staff

AAFP Board Chair Robert Wergin, M.D., of Milford, Neb., recently took on rising prescription drug prices, inadequate Medicare Part D plans and untenable administrative burdens shouldered by family physicians -- and packaged the trifecta of issues up in a succinct appeal to CMS.

[Medical golden and silver capsules spilled out of an open capsule on dollar bills.]

In a March 30 letter(1 page PDF) to CMS Acting Administrator Andy Slavitt, Wergin pressed the agency to review and, if necessary, revise certain requirements associated with Part D Plans.

Of particular interest to the AAFP were Medicare Advantage plans and Medicare prescription drug plans.

Wergin pointed out that drug prices had been spiraling out of control and that the increases had been "well documented" during the past year.

The rising drug prices were causing Part D plans to alter formularies and implement cost increases that then impacted seniors in the form of higher premiums and co-pays.

"In response to the growing costs of pharmaceutical drugs, Part D plans and others have developed prior authorizations as a means to control costs," said Wergin.

Unfortunately, family physicians then have to deal with the red tape associated with prior authorizations and write countless letters on behalf of patients to help them get the drugs they need.

"Prior authorizations and letter writing plague physicians by diverting physician time away from direct patient care," said Wergin.

He referenced AAFP policy that specifically supports a "physician- and patient-friendly option" on the issue and calls for physicians to be able to select drugs for a patient that are not included on a plan's formulary.

That policy also calls for the design of drug formularies that "offer patients multiple levels of drug choices -- from more to less restrictive -- with accompanying patient cost sharing levels to account for variables including patient preferences."

The AAFP's advocacy on behalf of family physicians and patients was in direct response to a substitute resolution adopted by the 2015 Congress of Delegates in Denver.

Resolution No. 313 was introduced by the Mississippi AFP and asked the AAFP to work with CMS to modify Medicare Part D plans to give patients adequate and affordable drug choices and to remove hindrances that delay the provision of timely and quality health care.