Most Pharmacists Participating In Medicare Rx Benefit Are Paid Within 30 Days, CMS Survey Says

The pharmacy benefit managers who reimburse pharmacists for claims submitted to Medicare prescription drug plans typically provide the payments within 30 days, according to a CMS study released on Wednesday, CQ HealthBeat reports. The study includes data from 20 drug plans, which account for 94% of enrollment in the Medicare prescription drug benefit. The plans completed an online survey in April, and additional information was obtained via telephone from plans that submitted unclear or incomplete online responses. According to the study, 18 of the 20 plans said they pay pharmacists within 30 days of receipt of the first "clean" claim in the billing cycle. The other two plans have contracts that lead to payment within 30 days in most cases, the study finds. In addition, the study finds that most plans have a billing cycle of 15 day or less, and some have cycles of seven to 10 days (Carey, CQ HealthBeat, 6/22).

Comments, Implications
Mark Merritt, president of the Pharmaceutical Care Management Association, which represents PBMs, said "These data confirm that pharmacists are being paid promptly in Medicare Part D just as they are in the commercial market." Crystal Wright of the Association of Community Pharmacists Congressional Network, which represents 15,000 independent pharmacists, said the study is flawed because it asked PBMs to report data voluntarily. "Nobody's looking over the shoulder of PBMs," she said (CQ HealthBeat, 6/22). Groups representing independent pharmacists have said that payments under the Medicare drug benefit have been too slow and too small for community pharmacies to cover their expenses. The pharmacists have called for passage of legislation (S 2563, HR 5182) that would require "prompt pay" of claims submitted to Medicare drug plans. Both bills have bipartisan co-sponsors (Kaiser Daily Health Policy Report, 5/23). CMS said it will continue to track the payment process and address any complaints from pharmacists, beneficiaries and participating plans (CQ HealthBeat, 6/22).


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