CONGRESS EYES MEDICARE PART D PAYMENT REFORMS

JUNE 01, 2006

Responding to concerns of pharmacists over slow-footed drug-claim reimbursement under the new Medicare Part D prescription programs, members of Congress are sponsoring legislation to correct the problem.

One new bill, introduced by Sen Max Baucus (D, Mont), would require Medicare prescription drug plans to pay interest on approved claims to pharmacies if the plans do not provide reimbursements in a timely manner. The bill would require drug plans to pay reasonable dispensing fees to participating pharmacies, as well as providing toll-free hot lines to furnish pharmacists with timely answers to their questions.

The bill would further prohibit the "cobranding" of Part D identification cards—a practice that critics say misleads many beneficiaries into believing that they may obtain benefits only at the drug chain named on the card.

Separate legislation, introduced by Sens Thad Cochran (R, Mo), Mike Enzi (R, Wyo), and Jim Talent (R, Mo), also would require prompt payment of pharmacies' Part D claims and restrict cobranding. In addition, this new legislation would establish guidelines for medication therapy management programs under Part D and would institute a 2-year community-based demonstration program.




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