The shifting landscape of prescription drug delivery services and the impact on Medicare Advantage and Part D plans

Authored by Hubert Wong

To help prevent the spread of COVID-19, the Centers for Medicare & Medicaid Services (CMS) has implemented more flexible guidelines for Medicare Advantage (MA) and Part D plans. For retail pharmacies, Part D medication delivery documentation and signature log requirements are being temporarily suspended under these new guidelines for the delivery of prescription drugs. This leniency relaxation in the plan-imposed policies helps eliminate barriers for people wanting to have their prescription drugs delivered and encourages people to take advantage of this service.

According to Kaiser Family Foundation health statistics, the number of retail prescription drugs filled at pharmacies for Medicare and Medicaid in 2019 exceeded more than 1.6 billion in the United States. With the rapid rise of COVID-19 cases, U.S. consumers need to consider more convenient and safe options to fulfill their prescription drugs.

The impacts of COVID-19 on prescription drug delivery

Retail pharmacies have begun increasing their prescription drug delivery service options to meet increased demand due to the COVID-19 pandemic. Additionally, demonstrated by the recent launch of Amazon Pharmacy, the behavioral shift of consumers toward completing everyday errands from home has become increasingly more evident.

This extra convenience also creates more risks and responsibilities for retail pharmacies, health plans and healthcare providers to safeguard individuals’ protected health information under the Health Insurance Portability and Accountability Act (HIPAA). More prescription drug deliveries also add pressure on retail pharmacies to stay compliant with:

• Ensuring required temperature control guidelines of certain drugs during delivery
• Internal pharmacy documentation requirements
• Prescription drug delivery signature requirements upon returning to the standard policies
• Verification that only eligible medications are shipped based on state and federal laws and regulations

Retail pharmacies will also need to confirm that their systems are properly equipped to handle the influx of delivery orders, and that delivery routes are optimized to ensure that the prescription drugs arrive to individuals in a timely manner and in accordance with federal laws and regulations.

Cybersecurity and the future of Medicare Advantage and Part D delivery

As we gradually overcome the challenges of the pandemic, the industry will appear with a new look and set of players. The push by Amazon into the pharmacy space is one of many examples in how the landscape is changing for the future of MA and Part D plans for the delivery of prescription drugs.

These changes also highlight the importance of ensuring that pharmacies, health plans and healthcare providers are compliant with current and future laws and regulations, as well as underscoring the possibility of cyber threats. The proper tools and processes must be in place to combat cybersecurity threats now that more and more patient health data is vulnerable online.

For more information on how to better prepare your organization against cybersecurity threats and HIPAA compliance or to learn about optimizing your Medicare Advantage program, contact us now.