CONGRESS EYES MEDICARE PART D PAYMENT REFORMS

Pharmacy Times, Volume 0, 0

Responding to concerns of pharmacistsover slow-footed drug-claim reimbursementunder the new MedicarePart D prescription programs, membersof Congress are sponsoring legislationto correct the problem.

One new bill, introduced by Sen MaxBaucus (D, Mont), would requireMedicare prescription drug plans topay interest on approved claims topharmacies if the plans do not providereimbursements in a timely manner.The bill would require drug plans topay reasonable dispensing fees to participatingpharmacies, as well as providingtoll-free hot lines to furnishpharmacists with timely answers totheir questions.

The bill would further prohibit the"cobranding" of Part D identificationcards—a practice that critics saymisleads many beneficiaries intobelieving that they may obtain benefitsonly at the drug chain named onthe card.

Separate legislation, introduced bySens Thad Cochran (R, Mo), Mike Enzi(R, Wyo), and Jim Talent (R, Mo), alsowould require prompt payment ofpharmacies' Part D claims and restrictcobranding. In addition, this new legislationwould establish guidelines formedication therapy management programsunder Part D and would institutea 2-year community-based demonstrationprogram.