Medicare Prescription Drug Plan Reimbursement Delays Prompt Pharmacy Closures

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Pharmacy / Pharmacist
Article Date: 20 Sep 2007 - 2:00 PDT

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Delays in reimbursements from Medicare prescription drug plans for medications dispensed have prompted a number of community pharmacies to close 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 of delays in reimbursements from Medicare prescription drug plans.

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

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

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