Another PBM ‘Bait and Switch’?

Three members of the House of Representatives have asked Medicare to look into “what appear to be deceptive practices being used by Symphonix Health Insurance in their preferred provider agreements to mislead patients and direct business away from independent and community pharmacies across America.”

Reps. Doug Collins (R-Ga.), Peter Welch (D-Vt.), and Buddy Carter (R-Ga.) noted that, “Symphonix’s 2016 plan initially promised fair prices and reimbursement rates to seniors and pharmacists during the Medicare open enrollment period, only to lower drug reimbursement rates by over a third on the last day of enrollment.”

Symphonix (part of UnitedHealthcare) appears to be “once again engaging in similar ‘bait and switch’ practices,” the lawmakers said in a letter to the Centers for Medicare & Medicaid Services. While the 2016 plan allowed access to independent community pharmacies with no disincentives, the 2017 plan (renamed AARP®MedicareRx Walgreens) requires a $15 copay at an independent vs. a zero copay at a Walgreens.

“In short, Symphonix’s new plan raises concerns about anticompetitive behavior towards beneficiaries,” the letter stated.

Filed under: General Problems