Medicare-D plan ready to roll in October

Who better to design a patient-centered, pharmacy-friendly pharmacy benefit plan than a pharmacist?

That’s the premise behind a new Medicare-D plan making its debut this fall thanks to a group of independent pharmacists who got sick of being pushed around by the largest pharmacy benefit managers (PBMs) and decided to take matters into their own hands.

The result is Indy Health Insurance Co., a newly licensed insurance company on track to roll out its first Medicare-D plan offering in West Virginia this October when Medicare open enrollment begins.

“Ours is a 100% independent pharmacy and independent pharmacy organization-owned plan built on a network of 22,000 pharmacies across the country,” said Indy Health Insurance Board Chair Laura Atkinson. “We are creating a more transparent, affordable, cost effective alternative for independent pharmacies and their patients.”

Indy Health’s Medicare Part-D plan offers seniors an affordable prescription drug plan to go along with their Medicare medical plan. Indy Health Insurance allows plan participants to receive medications from their local community pharmacies in a preferred network and does not force the use of prescription mail order or large retail chain pharmacies. Under Indy Health, seniors are protected in their choice of pharmacy.

“It was important to us to protect patient access,” said Eric Belldina, owner of Belldina’s Pharmacy in Masonton and managing partner for Indy Health Solutions LLC, the parent company. “Community pharmacies are uniquely positioned to care for patients, meeting the same demands as the big-box retail pharmacies but with quality and attention to detail you’d expect from a community pharmacy.”
Independent pharmacies also can provide mail service if needed, which is often restricted under other plans, he added.

“Pharmacy access for patients within West Virginia has increasingly become an issue. With Indy Health, patients are once again empowered with the choice where they fill their prescriptions,” said Matt Walker, executive director of the West Virginia Independent Pharmacy Association.

Atkinson said, “the new plan is a true game-changer especially for rural plan participants who rely on their local pharmacies as their first line of defense for their health care needs but may have been blocked from access to those pharmacies due to ‘big box’ PBM prohibitions.”

Under Indy Health, pharmacies will pay no direct and indirect remuneration (DIR) fees — a type of “claw back” PBMs collect to offset Medicare plan member costs. In 2018 small pharmacies paid average DIR fees of $129,613 per store — an 87% increase from 2017, according to a survey conducted by industry watchdog Pharmacists United for Truth and Transparency. DIR fees are a primary factor in the epidemic of community pharmacy closures.

“The absence of DIR fees is a big win for independent pharmacies, who could move from surviving the current U.S. drug pricing crisis to thriving,” said Atkinson.

With approved licensure in Arkansas, Indy Health will expand to Georgia, Pennsylvania, West Virginia and Illinois and has begun the application process with the Centers for Medicaid and Medicare (CMS). Upon CMS approval, Indy Health will begin enrolling patients in October.

The Indy Health Medicare-D plan is owned by investors in more than 34 states, including West Virginia.