PCMA Warns Against Prompt-Pay Deals for Medicare Providers |
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Written by U. S. Insurance News
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Monday, 16 June 2008 |
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What’s good for pharmacists will have to be good for other Medicare providers too—and none of it will be good for seniors.
That’s the message of a new ad issued by the Pharmaceutical Care
Management Association (PCMA). The ad warns 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 as those other providers.
“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 Mark Merritt, president and CEO of the PCMA. “This will lead to billions in new Medicare costs, make fraud, waste, and abuse tougher to detect, and offer no benefit whatsoever to seniors.”
A report issued earlier this year, “National Study to Determine the Cost of Dispensing Prescriptions in Community Retail Pharmacies,” confirms that pharmacy benefit managers (PBMs) are already being paid within 30 days. Other studies back this up. Medicare Part D claims are being paid within 21-25 days, according to the Centers for Medicare & Medicaid Services. And a study from PricewaterhouseCoopers (PwC) indicates Part D claims are paid within 23 days.
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 study by PwC. Medicare PDPs pay pharmacy claims within 30 days, 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.
PCMA is the national association representing the country’s PBMs, which administer prescription drug plans for more than 210 million Americans.
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