Medicare Drug Plans Paying Pharmacy Claims on Time

(Washington, DC)—In response to a vituperative statement from the independent pharmacy lobby, the Pharmaceutical Care Management Association (PCMA) today reiterated that Medicare drug plans are paying pharmacy claims on time. Regrettably, the independent pharmacy lobby continues to push a protectionist agenda that would add billions in unnecessary drug costs to seniors and the disabled, Part D plans, and the Medicare program. Specifically:

Berry-Jones Bill Could Increase Medicare Costs for Seniors, Disabled & Part D by Billions. The independent pharmacy lobby is pushing HR 1474, “the Fair and Speedy Treatment (FAST) of Medicare Prescription Drug Claims Act.” HR 1474 is sponsored by Representatives Marion Berry (D-Ark.) and Walter Jones (R-N.C.). While the exact costs of HR 1474 have not been quantified, legislation introduced in the last Congress by Representatives Berry and Jones mandating prompt-pay standards and other costly provisions would have increased Medicare costs by $55 billion and, in addition, would have increased beneficiaries’ premiums, cost-sharing, and out-of-pocket costs by more than $30 billion over ten years.

PCMA Member Companies Paying Clean Claims within 30 Days and Have Pledged to Continue Doing So. In 2006, PCMA member companies publicly and vocally pledged to pay pharmacists for Medicare Part D pharmacy claims within 30 days of receipt of clean claims. PCMA member companies are meeting this standard and have taken a leadership role in addressing some pharmacists’ concerns in this area.

30-Day Timeframe Consistent with Medicare, Commercial Market. PCMA’s prompt payment pledge is a standard consistent with Medicare Parts A & B, 43 states, and the federal employees’ health plan. Nearly all commercial plans pay on a 30-day standard plan.

CMS Survey Finds Medicare Part D Plans Paying within 30 Days. In 2006, a survey conducted by the Centers for Medicare & Medicaid Services (CMS) found that 18 of the top 20 Medicare prescription drug plans (PDPs) were paying pharmacy claims on a twice-a-month billing cycle of 15 days or less. CMS also stated that, ‘outside of Medicare, payment within 30 days is largely the industry standard, indicating that the payment timelines in Medicare are comparable to or better than those that exist elsewhere in the health insurance industry.’

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PCMA is the national association representing America’s pharmacy benefit managers (PBMs), which lower the cost of prescription drugs for more than 200 million Americans with coverage provided through Fortune 500 employers, health insurers, labor unions, and Medicare Part D

Contact Information:
Phil Blando, 202-207-3614
Charles Coté 202-207-3605