Outside fill prescriptions - is it OK?
Many outpatient pharmacists have contacted the Guild about prescriptions for Kaiser patients being transferred to non-Kaiser pharmacies like CVS and Walgreens. Clearly this is an issue for the Guild and we asked Kaiser why Guild bargaining unit work was taken without bargaining.
Below is the response Kaiser gave us. The Guild will vigorously pursue negotiations and NLRB actions to prevent the loss of bargaining unit work except where required by law.
Howard Hertz, Pharm.D.
As a Medicare Advantage Organization and Part D Sponsor, Kaiser Permanente is obligated to provide appropriate access to medications during disasters and emergencies (Wildfires, COVID-19, etc).
CMS expects Part D sponsors to take certain actions in response to disasters or emergencies that are considered reasonable in providing appropriate access to Part D medications when disruption to the pharmacy network occurs or is anticipated. Part D sponsors must ensure enrollees have adequate access to covered Part D drugs dispensed at out-of-network pharmacies when those enrollees cannot reasonably be expected to obtain covered Part D drugs at a network pharmacy. Enrollees remain responsible for any cost sharing under their plan and additional charges (i.e., the out-of-network pharmacy’s usual and customary charge), if any, that exceed the plan allowance.
As a contingency and temporary measure, National KP Pharmacy leadership pre-emptively opened the retail network nationally to 6 major chains on March 18, 2020 to ensure appropriate member access was maintained during the COVID-19 pandemic. Based on early projections and developing stay at home orders that varied region to region, it was unclear what the impact on pharmacy access would be.
Pharmacy Benefit Management (PBM) network configuration changes take several days to implement, KP Pharmacy made the strategic decision to put this measure in place before access issues arise.
National KP Pharmacy intention was to only communicate to members about the opening of the retail network if KP’s own pharmacies would not have been able to handle the increased volume created by the COVID-19 crisis. National KP Pharmacy also instructed our PBM partners to communicate with pharmacy chains to not announce the opening of the network until such time that Kaiser Permanente directs them to. With significant volume being switched to mail order to support social distancing the access issues did not materialize and National KP Pharmacy is in progress of returning the pharmacy network to pre-COVID status (targeting effective May7).
National Pharmacy has been closely monitoring claim volumes at our own pharmacies as well as external pharmacies. We have not seen any significant increase in the external pharmacy network.