Bill To Prevent Delay Of Medicare Prescription Drug Plan Pharmacy Payments

Armen Hareyan's picture

Medicare Prescription Drug Plans


Senate Finance Committeeleaders on Thursday introduced a bill (S 1954) that would requireMedicare prescription drug plans to reimburse pharmacies within 14 daysfor electronically submitted claims and within 30 days for paperclaims, CQ HealthBeatreports. Committee ranking member Chuck Grassley (R-Iowa) said, "Forpharmacists, it will ensure that they are reimbursed on time, that theyknow the drug prices in the contracts they sign, that toll-freepharmacist help lines are established at both CMS and the prescription drug plans, and that pharmacists wanting to participate in prescription drug plans are able to do so."

According to the National Community Pharmacists Association,which supports the legislation, community pharmacies often must waitfour weeks or longer for reimbursements from Medicare prescription drugplans, although in most cases, they must pay their suppliers every 15days. As a result, "the average community pharmacy has taken out loansof $70,000 and many have loans in the hundreds of thousands of dollarsto maintain cash flow, a dangerous proposition for any small-businessowner," NCPA said. However, according to the Pharmaceutical Care Management Association,the bill would lead to increased costs and administrative requirementsfor Medicare prescription drug plans without any benefit tobeneficiaries.

PCMA said, "Reducing the payment cycle to 14days for pharmacists in Medicare is less than half the 30-day standardused across the health sector." In addition, the legislation wouldlimit the ability of Medicare prescription drug plans to encouragebeneficiaries to use mail-order pharmacy services and reducecompetition among pharmacies, both of which could increase costs, PCMAsaid (Reichard, CQ HealthBeat, 8/3).

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