PHARMACIST ANGST OVER PART D PAYMENT DELAYS UNFOUNDED, SAYS CMS

Pharmacy Times, Volume 0, 0

Community pharmacists complaining of severe cashflow problems under the new Medicare Part D drugbenefit drew little sympathy from a top Medicare officialduring congressional hearings on the program'simpact on pharmacy.

Testifying before the House Energy and CommerceHealth Subcommittee, Centers for Medicare &Medicaid Services (CMS) Deputy Administrator LeslieNorwalk portrayed the reimbursement delays thathave bedeviled pharmacists as a short-lived problemresulting from the switch from the state Medicaid paymentsystems to Part D.

Despite the complaints of pharmacists, "a clearmajority of [Part D] prescription drug plans are payingpharmacies well within the industry standard of 30days from the time a clean electronic claim is submittedto the time a pharmacy receives payment," shetold the subcommittee.

One recent CMS survey cited by Norwalk found thatup to 18 of the top 20 private drug plans (PDPs) paypharmacy claims on a twice-a-month billing cycle of 15days or less. "A 15-day billing cycle generally providespharmacies with payment within 21 to 25 days," shetold Congress. "These top plans account for more than90% of the drug coverage for Medicare beneficiaries."

Officials at the National Community PharmacistsAssociation (NCPA) voiced objections to claims that a30-day payment period is an acceptable "industrystandard" for pharmacies. "Although that schedulemight work for doctors and hospitals?it does notwork for pharmacists, whose suppliers—such as drugwholesalers—demand payment much more frequently," the NCPA officials said.

Norwalk, however, assured Congress that CMS hasinvestigated numerous complaints from pharmacistsconcerning Part D payment delays and found no evidenceof systematic foot-dragging by PDPs. "The resultof the vast majority of these investigations has beenthat the plan has paid the pharmacy in accordancewith the terms of its contract," she said.

"The Medicare prescription drug benefit representsa new line of business for the pharmacies, but it doesnot differ substantially from the private commercialmarket with which they are already familiar," Norwalktold the subcommittee. "Thus, the contract termsrequire that claims for medications dispensed to peoplewith coverage under the Medicare prescriptiondrug benefit are being paid in a time frame with whichpharmacies are accustomed and within which theyknow how to operate."