Doctors, Hospitals, and Other Providers Would
Likely Demand Similar Treatment Next Year

(Washington, DC)- The Pharmaceutical Care Management Association (PCMA) released a new ad today warning policymakers that other Medicare providers-including doctors and hospitals-would likely demand the “same prompt-pay deal” next year if Congress requires pharmacists to be paid twice as fast them in Medicare.

“Paying one group of Medicare providers twice as fast as all the others will create a ‘stampede’ of other providers demanding the same treatment next year,” said PCMA President and CEO Mark Merritt.  “This will lead to billions in new Medicare costs, make fraud, waste, and abuse tougher to detect, and offer no benefit whatsoever to seniors.”

Meanwhile, the drugstore lobby’s own study[1] confirms that they are already being paid within 30 days. Three separate but remarkably consistent studies highlight that PBMs are paying claims on time.

• Grant Thornton study (the drugstore lobby’s own study) that shows pharmacies are being paid within 30 days (See Page 15 for findings on average payment time). 
• Part D claims are being paid within 21-25 days, according to the Centers for Medicare & Medicaid Services. 
• Part D claims are paid within 23 days, according to PricewaterhouseCoopers (PwC).

Legislation that would make Medicare prescription drug plans (PDPs) pay drugstores twice as fast as Medicare pays other providers could cost the program and its beneficiaries at least $3.3 billion over the next decade according to a new study by PwC.   Medicare PDPs pay pharmacy claims within 30 days, a standard consistent with Medicare Parts A & B, the federal employees’ health plan, and the private sector. The 30-day payment standard allows plans to batch claims for administrative efficiency and conduct audits to detect fraud and abuse.

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PCMA is the national association representing America’s pharmacy benefit managers (PBMs), which administer prescription drug plans for more than 210 million Americans with health coverage provided through Fortune 500 employers, health insurance plans, labor unions, and Medicare Part D.