WASHINGTON – The Senate Finance Committee has unveiled bipartisan legislation that aims to improve pharmacies’ Medicare drug benefit policies.
The Pharmacy Access Improvement, or PhAIm Act, would require that insurers speed up their reimbursements to pharmacies. Information hotlines for pharmacists and physicians would also be established under the act.
The legislation, introduced Aug. 3 would also prohibit “co-branding” – a practice in which private insurers issue cards bearing the name or logo of a pharmacy.
Co-branding leads some Medicare beneficiaries to incorrectly believe they can only obtain their drugs at a specific pharmacy.
A spokesperson for the Senate Finance Committee said the act does not change reimbursement rates for pharmacies.
“For pharmacists, it will ensure that they are reimbursed on time, that they know the drug prices in the contracts they sign, that toll-free pharmacist help lines are established at both (The Centers for Medicare & Medicaid Services) and the prescription drug plans, and that pharmacies wanting to participate in prescription drug plans are able to do so,” said Sen. Charles Grassley (R-Iowa), chairman of the Senate Finance Committee.
The Pharmaceutical Care Management Association voiced its opposition to the PhAIm Act in an August 2 press release. PCMA takes issue with several provisions, including the “prompt pay” requirement for Medicare-covered drugs.
“Reducing the payment cycle to 14 days for pharmacists in Medicare is less than half the 30-day standard used across the healthcare sector, including physician and hospital claims in Medicare Parts A&B, the federal employees’ health benefits plan and 43 states,” PCMA said. “It would thrust new costs and administrative burdens upon Part D sponsors without offering any corresponding upside for beneficiaries.”
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Pharmacy benefit managers promote the mail-service pharmacy option as a 10-percent saver on the cost of prescriptions, and provisions in the PhAIm Act threaten to limit pharmacies’ ability to encourage the appropriate use of the mail-service pharmacy option as a means to save money for beneficiaries and the program itself, PCMA said. An analysis by the Lewin Group projects that the use of mail-service pharmacy could save Medicare $48 billion over the next decade, the release noted.