Part D Threatens Pharmacists' Livelihood

AUGUST 01, 2006
Fred M. Eckel, RPh, MS; Pharmacy Times Editor-in-Chief

It has become painfully apparent in recent months that Medicare Part D has problems that are much more deep-rooted than the difficulties at the start of the program. The issues with the program, as currently operated, threaten the livelihood of pharmacists. Evidence is everywhere. Witness the growing number of pharmacies slipping into debt, being forced to lay off staff, and even facing closure.

The problems include inadequate reimbursement levels and slow payment. In many cases, reimbursement has been set at a level that makes it difficult to break even, let alone make a profit. The financial impact has been multiplied by the large number of dual eligibles moving from Medicaid coverage to private plans.

Many pharmacists are being hurt by reimbursement levels that are not only much lower than those of Medicaid programs, but also lower than preexisting non-Part D third-party programs. It is reasonable to expect that, at the very least, reimbursement should be set at the levels previously accepted among third-party payers.

Another problem is that reimbursement takes a long time to arrive. Exactly how long is a subject of debate, with differing claims emerging from pharmacy benefit managers, insurers, and the Centers for Medicare & Medicaid Services.

What is clear, though, is that there is enough delay to cause major problems. During the early days of the program, independent pharmacies expressed fears that slow payment would cause serious cash flow problems. Unfortunately, those fears were well-founded. Independent pharmacists cannot survive payment delays, and reimbursement should occur within 14 days.

There are signs that Congress is responding to our concerns, with bills introduced by Reps Walter B. Jones (R, NC) and Marion Berry (D, Ark) and by Sen Thad Cochran (R, Miss) that could fix at least some of the problems. With so much at stake, however, any attempts to mend the holes in the Part D program will be controversial and fiercely argued. That makes it even more important that our voices are heard.

You can help by sharing your experiences at You also can play a part by writing to legislators. The way this program evolves will make a big difference in determining whether patients continue to have a place they can go to get the medications they need.

Mr. Eckel is professor and director of the Office of Practice Development and Education at the School of Pharmacy, University of North Carolina at Chapel Hill.