Community pharmacists who submit reimbursement claims electronically to Medicare Part D drug plans would receive payment in 14 days or less, under new legislation introduced by Senate Finance Committee Chairman Max Baucus (D, Mont) and the panel's top-ranking Republican, Iowa Sen Charles Grassley.
The bill would further require that reimbursements to electronic- filing pharmacies be made instantly via electronic funds transfer- an approach designed to eliminate "the check's in the mail" excuses from Medicare drug plans. Pharmacies that file paper claims for Part D drugs would have to be reimbursed within 30 days.
Noting that pharmacists are "struggling" due to slow payments for Part D drugs, Baucus told Congress, "We must act now, before pharmacists find that they are no longer able to provide drugs to Medicare beneficiaries, or to provide drugs at all."
In addition to requiring prompt payment for claims, the legislation would prohibit drug chains from placing their logos on Part D membership cards-a practice Sen Baucus called "confusing" to Medicare patients. The bill also would require plans to allow "safety net pharmacies" that serve "vulnerable patients" to join their networks.
Still another provision would require plans to provide pharmacists with more accurate and updated information about reimbursement rates before a drug is dispensed. "The problems that pharmacists are facing...are real," and "they are not going away," said Baucus.
Although the annual HIV diagnosis rate between 2010 and 2014 decreased for black individuals by 16.2%, blacks remain disproportionately affected by HIV/AIDS.
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