MEDICARE IGNORES PHARMACY CALLS TO SPEED REIMBURSEMENT

Pharmacy Times, Volume 0, 0

Medicare officials are turninga deaf ear to pleas frompharmacy and congressionalleaders to speed up paymentsto community pharmacistsparticipating in the new Part Dprescription drug plan.

At least 41 House Republicanshave been urgingthe agency to put an end tothe cash-flow problems afflictingmany independent pharmacies.Pharmacists at thesestores blame pharmacy benefitmanagers for failing topay them in a timely manner.

In a written appeal to theCenters for Medicare & MedicaidServices (CMS), the 41GOP lawmakers asked theagency to require plans topay pharmacies within 14days of a prescription's beingfilled. They also called fornew requirements offeringpharmacists electronic paymentsfor Part D prescriptionsdispensed.

At least 127 members ofCongress are cosponsoringlegislation sponsored by RepsWalter Jones (R, NC) andMarion Berry (D, Ark) to mandateprompt payment forpharmacies.

CMS officials, however, areresisting pressure to intercedeon behalf of pharmacists.They contend that theinitial problems associatedwith the new drug programhave been overcome and thatmost pharmacists are receivingPart D reimbursementpromptly.

According to the CMS officials,the majority of claimsfrom pharmacists are paidwithin the 14-day time frameenvisioned by the House legislation,and 18 of the 20 largestPart D plans pay all claimswithin 30 days of receipt. CMSofficials also have stated that,"outside of Medicare, paymentwithin 30 days is largelythe industry standard?thepayment time lines inMedicare are comparableto or better than thosethat exist elsewhere in thehealth insurance industry."