Collins Challenges Insurer on Behalf of Patients, Pharmacies

Nov 16, 2016
Press Release

WASHINGTON—Congressman Doug Collins joins Congressmen Peter Welch and Buddy Carter in addressing the potentially deceptive practices of Symphonix Health Insurance. The company has introduced policies that appear to mislead patients and unfairly siphon business from independent and community pharmacies. The full letter is available below:

Mr. Andrew Slavitt

Acting Administrator

Centers for Medicare and Medicaid Services

200 Independence Avenue S.W., Room 314-G

Washington, DC 20201

Dear Acting Administrator Slavitt,

We are writing you in regards to 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.

Previously, Symphonix plans have generally been popular with independent and community pharmacies because the plans do not retroactively assess direct and indirect remuneration (DIR) fees.  DIR fees negatively impact pharmacies and patients by distorting medication costs and reimbursement rates, increasing community pharmacies’ costs by thousands of dollars each month and inhibiting the ability of local pharmacists to provide quality care throughout Georgia and across the country.

However, this is not the first time Symphonix’s plans have caused concern for community pharmacies across America. 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. This dishonest practice forced some pharmacies to operate at a loss on the same drug lists that showed a fair reimbursement on during open enrollment. Such practices are extremely misleading, detrimental to patients’ access to healthcare, and harmful to community pharmacies’ abilities to operate in senior and rural communities.

Unfortunately, it appears that Symphonix is once again engaging in similar “bait and switch” practices through the inclusion of anticompetitive contractual provisions in their 2017 provider agreements.  In 2016, the Symphonix PrimeSaver Rx plan provided coverage at community and independent pharmacies across America. Beneficiaries of this plan recently received a letter informing them that the plan name would be changed in 2017 to AARP® MedicareRX Walgreens and that they would soon be receiving an updated member ID card. However, the letter failed to disclose that patients would be unable to fill prescriptions at community pharmacies unless they were willing to pay a $15 copay per drug – a significant change from the year prior. We are concerned that Symphonix has misled beneficiaries by effectively forcing them onto a different health plan, saddling patients with additional costs while failing to inform them about the updated terms of the provider agreement.

Under Symphonix’s AARP® MedicareRX Walgreens plan, patients are strongly incentivized to use Walgreens pharmacies at the expense of community pharmacies. The plan provides drugs at no additional out of pocket cost if beneficiaries choose to fill their prescriptions at Walgreens. Although patients still have the option of using their local pharmacies in theory, many beneficiaries cannot afford the new copay on the numerous medications they need each month for an entire year. In short, Symphonix’s new plan raises concerns about anticompetitive behavior towards beneficiaries. Symphonix’s change in policy could jeopardize healthcare access by unnecessarily increasing out of pocket expenses for drugs at local pharmacies and forcibly redirecting their beneficiaries.    

Throughout the United States, local pharmacies are essential providers of care and community pharmacists are critical players in the rural healthcare ecosystem. Many patients may not have access to Walgreens pharmacies and have developed lifelong relationships with their current community pharmacists, who have been treating them for many years. Independent pharmacists ensure that patients are staying on track with their medication regimen – preventing serious illnesses and hospitalizations, and helping control healthcare costs.  If an insurance plan provides unfavorable coverage for local pharmacies, it disrupts an important rural healthcare safety net. Ultimately this harms rural patients’ health and threatens local pharmacies’ existence.

We respectfully request that you look into the behavior of Symphonix as well as the current policies related to Symphonix’s decision to change their plan terms at the expense of independent pharmacists and that you share your findings with us. Additionally, we request that you direct Symphonix to immediately notify current beneficiaries about the significant changes to provider networks in 2017 as this information is essential so that beneficiaries—particularly beneficiaries in underserved areas—have the information they need to make an informed decision about their choice of Part D plan and participating pharmacy provider. Thank you for your consideration of our concerns, and those of elderly and rural patients and local pharmacists who provide beneficiaries with access to affordable, quality healthcare.


Doug Collins                               Peter Welch                                       Buddy Carter

Member of Congress                  Member of Congress                         Member of Congress