Medicare Prescription Drug Plan Reimbursement Delays Prompt Pharmacy Closures

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Prescription Drug Plan Reimbursement


Delays in reimbursements from Medicare prescription drug plans formedications dispensed have prompted a number of community pharmacies toclose since the launch of the program in January 2006, the AP/Long Island Newsday reports. According to the National Community Pharmacists Association,1,152 community pharmacies closed in 2006, in large part because ofdelays in reimbursements from Medicare prescription drug plans.

CharlieSewell, vice president of government affairs for NCPA, said thatMedicare prescription drug plans "get paid up front, and they have avested interest in sitting on that money as long as possible." NCPAsupports the passage of a bill (HR 1474)sponsored by Rep. Marion Berry (D-Ark.) that would require Medicareprescription drug plans to reimburse pharmacies within 14 days ofelectronic claims submissions and within 30 days of other claimssubmissions. The legislation has about 200 co-sponsors in the House andabout 12 in the Senate.

Health insurers and pharmacy benefitmanagers, which oppose the bill, maintain that, because Medicare andprivate insurers have 30 days to reimburse physicians and hospitals,they should have the same amount of time to reimburse pharmacies. MarkMerritt -- president and CEO of the Pharmaceutical Care Management Association,which represents PBMs -- said, "Thirty days is a reasonable standard byanyone's count, and we pay within 30 days" (Freking, AP/Long Island Newsday, 9/17).

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