It has become painfully apparent inrecent months that Medicare Part Dhas problems that are much moredeep-rooted than the difficulties at thestart of the program. The issues with theprogram, as currently operated, threatenthe livelihood of pharmacists. Evidence iseverywhere. Witness the growing numberof pharmacies slipping into debt,being forced to lay off staff, and even facingclosure.
The problems include inadequatereimbursement levels and slow payment.In many cases, reimbursement hasbeen set at a level that makes it difficultto break even, let alone make a profit.The financial impact has been multipliedby the large number of dual eligiblesmoving from Medicaid coverage to privateplans.
Many pharmacists are being hurt byreimbursement levels that are not onlymuch lower than those of Medicaidprograms, but also lower than preexistingnon-Part D third-party programs. Itis reasonable to expect that, at thevery least, reimbursement should beset at the levels previously acceptedamong third-party payers.
Another problem is that reimbursementtakes a long time to arrive. Exactlyhow long is a subject of debate, with differingclaims emerging from pharmacybenefit managers, insurers, and theCenters for Medicare & MedicaidServices.
What is clear, though, is that there isenough delay to cause major problems.During the early days of the program,independent pharmacies expressed fearsthat slow payment would cause seriouscash flow problems. Unfortunately, thosefears were well-founded. Independentpharmacists cannot survive paymentdelays, and reimbursement should occurwithin 14 days.
There are signs that Congress isresponding to our concerns, with billsintroduced by Reps Walter B. Jones (R, NC)and Marion Berry (D, Ark) and by Sen ThadCochran (R, Miss) that could fix at leastsome of the problems. With so much atstake, however, any attempts to mendthe holes in the Part D program will becontroversial and fiercely argued. Thatmakes it even more important that ourvoices are heard.
You can help by sharing your experiencesat www.pharmacytimes.com/blogEPT. You also can play a part by writingto legislators. The way this programevolves will make a big difference indetermining whether patients continueto have a place they can go to get themedications they need.
Mr. Eckel is professor and director ofthe Office of Practice Developmentand Education at the School ofPharmacy, University of NorthCarolina at Chapel Hill.