Medicare Compliance & Reimbursement

Bipartisan support encourages insiders

A new bill in the U.S. Senate could lead to speedier payments from Part D prescription drug plans ...quot; a development that could save you from borrowing to cover expenses.

The Senate bill, the Pharmacy Access Improve-ment Act of 2007 (S. 1954), has a companion bill in the U.S. House of Representatives, the Fair & Speedy Treatment of Medicare Prescription Drug Claims Act (H.R. 1474).

Under the Senate proposal, the PDPs would submit Part D pharmacy reimbursement claims within 14 days by electronic funds transfer, and paper claims within 30 days.

Senate Finance Committee Chairman Max Baucus (D-MT) and Committee ranking minority member Charles Grassley (R-IA) introduced the bill Aug. 2.

Support Grows

In addition to taking on the timing of payments, the bill offers the following Part D fixes favorable to pharmacists:

• A ban on "co-branding" on Medicare identification cards and other materials.
• A requirement that puts limits on the number of non-retail pharmacies that can be counted as retail.
• A change that would require drug plans to disclose their maximum allowable cost pricing on generic medications.

The bill's original cosponsors are a bipartisan group including Sens. Blanche Lincoln (D-AR), Olympia Snowe (R-ME), Kent Conrad (D-ND), Gordon Smith (R-OR), Charles Schumer (D-NY), Pat Roberts (R-KS), Ken Salazar (D-CO), Thad Cochran (R-MS), Jeff Bingaman (D-NM), and Michael Enzi (R-WY).

In the U.S. House of Representatives, a similar bill, the proposed Fair and Speedy Treatment (FAST) of Medicare Prescription Drug Claims Act of 2007 (H.R. 1474), has already garnered 190 cosponsors.

"The painfully slow reimbursements don't just affect Medicare patients, but entire neighborhoods and communities in the event a pharmacy is forced to close," says John Tilley, president of the National Community Pharmacists Association.

The problem: Medicare pays pharmacy benefit managers (PBMs) each month in advance. But "delay tactics" allow them to hold on to the interest funds while community pharmacies wait for reimbursement, charges Bruce Roberts, NCPA executive vice president and chief executive.

"While PBM profits rise, community pharmacies have been forced to borrow tens of thousands of dollars to cover their expenses," Roberts explains.