Press Releases
WASHINGTON, DC – U.S. Senator Pat Roberts today introduced legislation to improve the Medicare prescription drug program making it easier for community pharmacists to continue to provide access to quality prescriptions and health care information to patients.
“I have heard from pharmacists in Kansas about the hassles of doing business with plans in Medicare Part D,” Senator Roberts said. “Delays in reimbursement and other red-tape issues have made our community pharmacists shoulder a financial burden often affecting their ability to offer services to Kansans and in some cases forcing them out of business.”
Senator Roberts is an original cosponsor of the Pharmacy Access and Improvement Act introduced by Senators Max Baucus (D-MT) and Chuck Grassley (R-IA).
A critical provision of the bill addresses problems with prompt reimbursement or “prompt pay”by requiring pharmacies be promptly paid within 14 days by plans participating in the Medicare Part D program. Currently some plans wait 30 days or longer to reimburse pharmacists for a claim forcing pharmacies to carry this debt.
The bill also requires that the Department of Health and Human Services (HHS) to set up a separate pharmacists’ toll-free hotline for Part D. This will ease some of the bottleneck problems occurring at 1-800-MEDICARE by allowing pharmacists a direct line to HHS. This section also requires the individual plans do the same for both pharmacists and physicians.
Another key provision restricts co-branding by prescription drug plans, prohibiting cards issued by plans from bearing the name, brand, logo or trademark of any pharmacy. This ensures that all pharmacies are on an even playing field, rather than plans directing patients to certain pharmacies over others.
The bill strengthens the standards for access to pharmacies under the Part D program by requiring that plans count only “open” pharmacies, those that are accessible to the general public, as meeting the standard for pharmacy participation under the Medicare Modernization Act. This section also allows pharmacies to initiate negotiations with plans under the “any willing pharmacy” provision regardless of previous offers from the plan.
The final section requires plans to update their prescription drug pricing standard at least every seven days. Drug pricing standards can change daily. The manufacturers raise prices, which the pharmacies must pay to buy the drug. Plans may only change the rate only once a month. Since prices typically go up, not down, that means that the plan is reimbursing the pharmacy's base rate for drugs at a lower rate than the pharmacy may have paid.
“As we implement Medicare Part D, we must make sure it operates in a way that preserves access to prescription drugs and does not have the unintended effect of making it extremely difficulty for community pharmacists to do business,” Roberts said. “Not only will the pharmacies benefit, but patients will too.”
Senator Roberts sponosored similar legislation in the last Congress. Roberts is a member of the Senate Committee on Finance and the Senate Committee on Health, Education, Labor and Pensions.
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“I have heard from pharmacists in Kansas about the hassles of doing business with plans in Medicare Part D,” Senator Roberts said. “Delays in reimbursement and other red-tape issues have made our community pharmacists shoulder a financial burden often affecting their ability to offer services to Kansans and in some cases forcing them out of business.”
Senator Roberts is an original cosponsor of the Pharmacy Access and Improvement Act introduced by Senators Max Baucus (D-MT) and Chuck Grassley (R-IA).
A critical provision of the bill addresses problems with prompt reimbursement or “prompt pay”by requiring pharmacies be promptly paid within 14 days by plans participating in the Medicare Part D program. Currently some plans wait 30 days or longer to reimburse pharmacists for a claim forcing pharmacies to carry this debt.
The bill also requires that the Department of Health and Human Services (HHS) to set up a separate pharmacists’ toll-free hotline for Part D. This will ease some of the bottleneck problems occurring at 1-800-MEDICARE by allowing pharmacists a direct line to HHS. This section also requires the individual plans do the same for both pharmacists and physicians.
Another key provision restricts co-branding by prescription drug plans, prohibiting cards issued by plans from bearing the name, brand, logo or trademark of any pharmacy. This ensures that all pharmacies are on an even playing field, rather than plans directing patients to certain pharmacies over others.
The bill strengthens the standards for access to pharmacies under the Part D program by requiring that plans count only “open” pharmacies, those that are accessible to the general public, as meeting the standard for pharmacy participation under the Medicare Modernization Act. This section also allows pharmacies to initiate negotiations with plans under the “any willing pharmacy” provision regardless of previous offers from the plan.
The final section requires plans to update their prescription drug pricing standard at least every seven days. Drug pricing standards can change daily. The manufacturers raise prices, which the pharmacies must pay to buy the drug. Plans may only change the rate only once a month. Since prices typically go up, not down, that means that the plan is reimbursing the pharmacy's base rate for drugs at a lower rate than the pharmacy may have paid.
“As we implement Medicare Part D, we must make sure it operates in a way that preserves access to prescription drugs and does not have the unintended effect of making it extremely difficulty for community pharmacists to do business,” Roberts said. “Not only will the pharmacies benefit, but patients will too.”
Senator Roberts sponosored similar legislation in the last Congress. Roberts is a member of the Senate Committee on Finance and the Senate Committee on Health, Education, Labor and Pensions.
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