ccpa SPEAKS OUT: CCPA Works to Improve Medicare Part D

MAY 01, 2007

The Medicare Part D Prescription Drug Benefit would not have been a success without the heroic efforts of community pharmacists on behalf of their patients. Community pharmacies, however, have encountered major cash-flow problems as a result of Part D that could put them out of business. Improvements must be made so that community pharmacies are paid promptly for providing vital health care services.

The Part D plans are paid each month in advance by Medicare. The Part D plans are using delay tactics, however, to enjoy a considerable interest-earning float on taxpayer dollars intended to reimburse pharmacies for serving their patients. These payment delays have forced many pharmacists to borrow tens of thousands of dollars every month to cover payroll, wholesaler bills, and other basic operating costs.

The Coalition for Community Pharmacy Action (CCPA) is currently working to improve Medicare Part D by supporting federal legislation that will ensure timely compensation for the services community pharmacies provide. Reps Marion Berry (D, Ark),Walter B. Jones (R, NC), Stephanie Herseth (D, SD), and Roger F. Wicker (R, Miss) have introduced legislation in the House of Representatives—the Fair and Speedy Treatment (FAST) of Claims Act of 2007 (HR 1474)—that will put an end to delayed reimbursements and materials that mislead beneficiaries.

The FAST Act defines clean claims and requires plans to reimburse providers via electronic funds transfer within 14 days for clean claims submitted electronically.

The FAST Act also provides clarification of cobranding rules. Advertising should not be allowed on the Part D benefit card or informational materials. Just as there is no advertising on the Social Security card, there should not be any advertising on certain Medicare Part D materials used for patient education. Marketing guidelines expressly prohibit steering patients in regard to Part D Plans, and likewise plans should not be allowed to steer patients toward a particular pharmacy by cobranding the benefit card and informational materials. Patients need to know that they have choices—a key policy goal of the creation of Part D.

CCPA is continuously working to gain support from members of Congress for the FAST Act, which so far has been cosponsored by >40 representatives. Similar legislation received the support of >170 members of the 109th Congress, including current Chairman John Dingell (D, Mich) of the Energy and Commerce Committee and Chairman Charles Rangel (D, NY) of the Ways and Means Committee.

CCPA appreciates the efforts of the original 10 sponsors who supported this legislation: Reps Walter B. Jones (R, NC), Thomas H. Allen (D, Me), Jo Ann Emerson (R, Mo), Stephanie Herseth (D, SD), Robert B. Aderholt (R, Ala), Joe Courtney (D, Conn), Sam Graves (R, Mo), Jerry Moran (R, Kan), Mike Ross (SD, Ark), and Roger F. Wicker (R, Miss). CCPA is working closely with members of the Senate Finance Committee to have similar legislation introduced in the Senate.

CCPA needs your help to ensure that community pharmacies are not forced to close or reduce hours as a result of slow Medicare reimbursement and unclear claims processing. Please visit to contact your representative, and ask him or her to cosponsor the FAST Act.

Ms. Khani and Mr. Sewell are co-presidents of the Coalition for Community Pharmacy Action.

The Coalition for Community Pharmacy Action (CCPA) is an alliance between the National Association of Chain Drug Stores (NACDS) and the National Community Pharmacists Association (NCPA), which together represents more than 55,000 community pharmacies. CCPA leverages the support, effort, and infrastructure of NACDS and NCPA while engaging community pharmacy to participate and advocate on issues affecting the industry.