CMS Statement on Freedom of Choice Issue

It has been brought to the attention of CMS Prescription Drug Program Officials that some nursing facilities have distributed letters to their patients falsely asserting that CMS has placed a requirement on facilities to contract only with Long Term Care pharmacies that currently meet all of the Performance and Service Criteria for LTC Network Providers under Medicare Part D.  We understand that this is causing some LTC facilities to exclude some pharmacies from servicing Part D patients resident in their LTC facilities. 

Please be advised that this is an inappropriate reading of the CMS requirements. On November 8, 2005, CMS issued the "Long-Term Care (LTC) Convenient Access Standard Statement" stating the following:  "We also reiterate our previous guidance that any pharmacy – whether it is a LTC or retail pharmacy – that can meet the ten performance and service criteria outlined in our March 2005 LTC Guidance and is willing to accept any other standard contracting terms and conditions established by the plan for its network pharmacies can participate as a LTC network pharmacy. As clarified in previous guidance, this means that network LTC pharmacies must have the capability to meet the performance and service criteria, either directly or through a subcontractor. It does not mean that prospective LTC network pharmacies must show that they currently provide such services or that they could provide all these service directly. The actual services that must be provided by the LTC network pharmacy will depend on the specific needs of the specific LTC facilities serviced by the pharmacy."