Community pharmacies have been plagued with slow and low reimbursement under Medicare Part D, according to lawmakers issuing legislation to speed up Medicare's pharmacy payments.
Reps. Marion Berry (D-Ark) and Walter Jones (R-NC) said on September 6 that their co-sponsored bill, HR 1474, would require that payments to community pharmacies be made within 14 days.
Currently, insurance companies offering Medicare Part D plans are waiting as long as they can - in some cases more than 90 days - to reimburse community pharmacies, said Charles Sewell, senior vice president of government affairs for the National Community Pharmacists Association.
"(Insurance companies) have a vested interest in sitting on that money as long as possible and collecting interest on it," Sewell said. "They'll deny the claim the first time through, even when it's a clean claim, and sit on the money as long as possible. Our pharmacies are all small businesses, and the average line of credit they've had to take out is about $70,000." Sewell added that Medicare Part D currently constitutes about 34 percent of community pharmacies' revenue.
"There is absolutely no excuse for the way our pharmacies have suffered," said Jones.
Jones and Berry said that the bill will prevent community pharmacies from shutting down, a factor they say endangers the drug access of people living in rural areas.
"I can ensure you that we are going to rally the American people," Jones said. "This is about their ability to have a pharmacist in their town that they can go and see."
While the bill's future in Congress is uncertain, Berry said its passage would provide more fairness than Medicare drug legislation does.
"You don't have to be broken out in brilliance to see that the Medicare Modernization and Prescription Drug Act of 2003 was never intended to help senior citizens or consumers or pharmacies in any way," Berry said. "It was meant to help pharmaceutical manufacturers and insurance companies."
HB 1474 is the House's version of similar legislation introduced in the Senate last month. The Pharmacy Access Improvement (PhAIm) Act would also speed up reimbursements to 14 days. Both bills would eliminate co-branding, the practice in which insurers brand health cards with the logo or name of a pharmacy chain.
In response to the PhAIm Act, the Pharmaceutical Care Management Association said the bill would "thrust new costs and administrative burden on Part D sponsors without offering any corresponding upside for beneficiaries."