30-Day Standard is Consistent with Medicare Parts A & B, 43 States, & FEHBP

(Washington, DC)—The Board of Directors of the Pharmaceutical Care Management Association (PCMA) today pledged that their companies will pay pharmacists for Medicare Part D pharmacy claims within 30 days of receipt of clean claims, a standard consistent with Medicare Parts A & B, 43 states, and the federal employees’ health plan. PCMA member companies are sponsors of six of the 10 national Medicare prescription drug plans and administer Part D for many other plans.

“The 30-day pledge signals Medicare drug plans’ continued commitment to fair and timely claims payments to America’s pharmacists,” said PCMA President Mark Merritt. “Working together, PBMs, drugstores, health plans, and others can make sure this new drug benefit continues to offer seniors the savings and access to the prescription drugs that they deserve. This pledge also sends a positive message to pharmacists, who have provided tremendous assistance to seniors since the start of this new benefit.”

With today’s announcement, PCMA member companies pledge to specifically:

Pay clean electronic claims within 30 days of the date of submission; and
A “clean claim” is defined to mean that the claim submitted has no defect or impropriety (including lack of substantiating documentation) or circumstance requiring special treatment that prevents timely payment.
The 30-day standard is the same payment standard that applies to doctors, hospitals, and other providers in Medicare Parts A & B. A 30-day timeframe is the pharmacy-claims standard in 43 states and is the standard applied to FEHBP, Members of Congress’ own health plan. The 30-day standard is applied to medical providers in the commercial marketplace and for business transactions and payments associated with credit cards and utilities. A 30-day standard helps improve quality, ensure accurate payments, and to prevent fraud and abuse, which costs the health care system billions of dollars annually and increases costs for consumers and purchasers.

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PCMA is the national association representing America’s pharmacy benefit managers (PBMs), which administer prescription drug plans for more than 200 million Americans with health coverage provided through small businesses, Fortune 500 employers, health insurers, labor unions, and Medicare Part D.

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