Pharmacy Times

MEDICARE IGNORES PHARMACY CALLS TO SPEED REIMBURSEMENT


Medicare officials are turning a deaf ear to pleas from pharmacy and congressional leaders to speed up payments to community pharmacists participating in the new Part D prescription drug plan.

At least 41 House Republicans have been urging the agency to put an end to the cash-flow problems afflicting many independent pharmacies. Pharmacists at these stores blame pharmacy benefit managers for failing to pay them in a timely manner.

In a written appeal to the Centers for Medicare & Medicaid Services (CMS), the 41 GOP lawmakers asked the agency to require plans to pay pharmacies within 14 days of a prescription's being filled. They also called for new requirements offering pharmacists electronic payments for Part D prescriptions dispensed.

At least 127 members of Congress are cosponsoring legislation sponsored by Reps Walter Jones (R, NC) and Marion Berry (D, Ark) to mandate prompt payment for pharmacies.

CMS officials, however, are resisting pressure to intercede on behalf of pharmacists. They contend that the initial problems associated with the new drug program have been overcome and that most pharmacists are receiving Part D reimbursement promptly.

According to the CMS officials, the majority of claims from pharmacists are paid within the 14-day time frame envisioned by the House legislation, and 18 of the 20 largest Part D plans pay all claims within 30 days of receipt. CMS officials also have stated that, "outside of Medicare, payment within 30 days is largely the industry standard?the payment time lines in Medicare are comparable to or better than those that exist elsewhere in the health insurance industry."