Study Indicates Strong Consumer Preference To Fix Medicare Part D, Medicaid Flaws

Armen Hareyan's picture
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Patients believe that access to their prescription medications for government health care programs should not be compromised by unfair reimbursement practices and policies to their community pharmacy providers, according to a new survey from the polling company, inc.

"Our patients have it right: they know community pharmacies play a critical role in their health care," said Stephen Giroux, PD, NCPA president and owner of five pharmacies in Western New York. "They want us there to address their health care needs. Now Congress needs to heed their request and pass specific Medicare and Medicaid reimbursement fixes before more local pharmacies are forced out of these government programs, or have to close their doors."

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The Coalition for Community Pharmacy Action--comprised of the National Community Pharmacists Association (NCPA) and National Association of Chain Drug Stores (NACDS)--commissioned the polling company, inc., to conduct a comprehensive survey of 1,000 pharmacy patients nationwide from November 26 - December 2, with a margin of error of (+/-) 3. From a legislative perspective, the level of patient support for fixing the current slow reimbursement of Medicare Part D prescription drugs by the pharmacy benefit managers (PBMs) that administer the plans, and the forthcoming cuts in the reimbursement of Medicaid generic prescription drugs was resounding.

The survey found 83 percent of respondents said it was unfair that "PBMs and prescription drug plans keep money as long as possible, allowing them to earn interest on it, while pharmacies must continue to provide their services and prescription drugs upfront to patients even though they haven't been paid." The survey also found 83 percent support "new legislation in Congress to ensure pharmacies providing Medicare Part D patients are reimbursed by the government within 14 days."

Slow pharmacy reimbursement of Medicare Part D prescription drug claims by PBMs cause cash flow problems for community pharmacies that force them to take out loans in the tens to hundreds of thousands of dollars range. The bills - H.R.1474, the Fair and Speedy Treatment of Medicare Prescription Drug Act of 2007, and S.1954, the Pharmacy Access Improvement Act (PhAIM) of 2007?require complete and accurate Part D claims submitted electronically be paid within 14 days by electronic funds transfer, and paper claims within 30 days.

In addition, the survey found 78 percent thought it was unfair that "under the new rule, pharmacies that participate in the Medicaid program would have to sell generic drugs at a loss." The survey also found 78 were less likely to support the new rule because "many community pharmacies will not be able to continue servicing Medicaid patients, including children," especially after they learn "over 28 million children in the U.S. get prescription medications paid for by the Medicaid and account for over half of the beneficiaries." Furthermore, the survey found 74 percent support legislation that would reimburse pharmacy more fairly.

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