Sending Office: Honorable Doug Collins
Sent By:


Request for Signature(s)

Dear Colleague,

Please join us in sending the attached letter to Administrator Verma in support of a provision included in the Centers for Medicare and Medicaid Services’ (CMS) proposed Part D rule.

Community pharmacists across the country are on the front line of our health care system, working with patients and doctors to provide care that is fast, effective, and affordable. However, pharmacy benefit manager (PBM) controlled pharmacy networks often
exclude community pharmacies because the PBMs that administer those networks often own direct competitors to the community pharmacies. These PBMs have redefined and modified the definition of retail pharmacy to exclude community pharmacies and funnel patients
to their own pharmacies, which are often more expensive and fail to provide comparable patient care.

This CMS proposal clarifies the definition of “retail pharmacy” and defines “mail order pharmacy” to ensure that PBMs cannot exclude similarly situated competing pharmacies from pharmacy networks by redefining what a qualifies as a retail pharmacy.PBMs would
not be able to exclude pharmacies from participating in Part D simply because they offer additional patient care services like home delivery or compounding in addition to retail pharmacy services. In doing so, CMS would ensure that pharmacies with unique and
innovative business and care delivery models are able to provide care to Medicare Part D patients. The proposal would ensure seniors have better access to care and would give small business pharmacies a more level playing field on which to compete with PBMs
while serving local communities.

For more information or to sign this letter, please contact Daniel Ashworth ( in Rep. Doug Collins office or Maddie Bushnell (
in Rep. Dave Loebsack’s office by January 16th, 2017.




Doug Collins                                                         Dave Loebsack

Member of Congress                                            Member of Congress




The Honorable Seema Verma


Centers for Medicare & Medicaid Services

200 Independence Avenue, S.W.

Washington, D.C. 20201


Dear Administrator Verma,

We write to express our support for a proposal included as part of the Centers for Medicare and Medicaid Services’ (CMS) proposed rule (Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs for Contract
Year 2019, docket number CMS-4182-P) for the 2019 Medicare Part D plan year. This proposal ensures that similarly situated pharmacies are not excluded from pharmacy networks on the basis of their pharmacy type classification.

Pharmacy Benefit Managers (PBMs) have continuously declined to permit willing pharmacies to participate in PBM networks on the grounds that they do not meet the Part D plan sponsor’s definition of a pharmacy type. In particular, PBMs have used “mail order”
pharmacy definitions to prevent many retail pharmacies with home delivery services from joining their network. Instead, PBMs place onerous requirements on community and independent pharmacies, such as being licensed in all fifty states, even if the pharmacy
only delivers within its state or region. This enables PBMs to steer patients to their own mail order pharmacies by excluding community pharmacies that provide better services at cheaper costs.

In fact, in 2014 the National Center for Biotechnology Information (a part of the National Institute of Health) found that “[t]hird-party payers, including Medicare, paid more for prescriptions dispensed at mail order pharmacies than for those dispensed
at retail pharmacies in the Medicare Part D program.”[1] PBMs who contract with these third-party payers, like Medicare, force payers to use the PBMs own mail-order pharmacy, thus reducing competition and patient
care. While many community retail pharmacies often provide home delivery for elderly or disabled patients, these pharmacies are able to provide face-to-face counseling with patients and faster delivery than large mail-order pharmacies.

We commend CMS for defining mail order pharmacy to ensure that community pharmacies are able to provide the best possible service to their patients, including home delivery, without being improperly excluded from the network. We also support the clarification
of the definition for retail pharmacies to include the key concepts of being open to the public and subject to retail cost-sharing. These definitions will serve to increase competition, decrease costs, and promote the best possible patient care for seniors.

Thank you for considering the negative impacts that the improper network exclusion of community pharmacies can have on patients. We encourage you to finalize this proposal without significant alterations in the Policy and Technical Changes to the Medicare
Advantage and the Medicare Prescription Drug Benefit Programs for Contract Year 2019, and appreciate your attention to this matter to improve care for seniors.



______________________                                                                ______________________

Doug Collins                                                                                       Dave Loebsack

Member of Congress                                                                           Member of Congress






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