Bipartisan Congressional Coalition Formed To Support Independent Pharmacists
Thirty-one members of Congress have formed a bipartisan group toadvocate for passage of bills that would establish reimbursementschedules and other guidelines for independent pharmacists working withinsurers and pharmacy benefit managers, CQ HealthBeatreports. The formation of the Congressional Community PharmacyCoalition comes amid concerns over conditions set under the 2003Medicare Part D prescription drug plan, which allows insurers andpharmacy benefit managers to set drug sales rates at just above cost,independent pharmacists say. In addition, community pharmacists saythat insurers and PBMs have been taking too much time to completereimbursements, forcing the pharmacists to take loans to maintain theirbusinesses or shut down.
Large pharmacy retailers are notaffected by the problem because they are big enough to negotiatedirectly with drug companies, and they can establish their owncorporate pharmacy benefit managers to work with the insurers, CQ HealthBeatreports. Rep. Anthony Weiner (D-N.Y.), the coalition's chair, in apress release said, "The deck is stacked against communitypharmacists."
One of the bills (HR 1474) being supported by the coalition calls for reimbursement of pharmacists within 14 days. The Pharmaceutical Care Management Associationin a statement said the 14-day time limit is unfair and would raisedrug costs. PCMA also said that "member companies have routinely paidclean claims within 30 days" and that the 14-day proposal "exceeds thepayment requirements of 43 states" (Lubbes, CQ HealthBeat, 10/1).
Reprinted with permission from kaisernetwork.org. Youcan view the entire Kaiser DailyHealth Policy Report, search the archives, and sign up for email deliveryat kaisernetwork.org/email. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, afree service of The Henry J. Kaiser Family Foundation.