- Resource Centers
At least half of the Medicare Part D drug-reimbursement claims submitted by independent pharmacies were not paid within 30 days, and more than 1 in 6 went unpaid for at least 2 months, according to new research by the University of Texas at Austin's Center for Pharmacoeconomic Studies.
The researchers traced payments for ~600,000 Part D claims from independent pharmacies. They found that 50% of those claims were paid >30 days after adjudication, and 17.1% took >60 days. Less than 1% of the Rx claims were paid within 2 weeks, which is "typically how often community pharmacies have to pay their wholesalers," said officials at the National Community Pharmacists Association (NCPA).
Ironically, pharmacies are suffering cash-flow problems even though the pharmacy benefit managers (PBMs) responsible for administering the various Part D plans are getting paid in advance by the federal government, said NCPA. The new Texas study "presents strong evidence that PBMs are gaming the system, making interest on the float they get by not paying pharmacies in a timely manner."