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Indie pharmacy applauds move in Congress to end aggressive Part B recoupment efforts

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ALEXANDRIA, Va. The independent pharmacy lobby is hailing a new effort by congressional Democrats to shield owner-operated pharmacies from burdensome financial obligations stemming from years of service to patients covered by Medicare Part B.

Reps. Tammy Baldwin, D-Wis., and Bart Stupak, D-Mich., have called on the Centers for Medicare and Medicaid Services to end what they claim are overly aggressive efforts by agency contractors to recoup monies paid to independent drug stores that supplied and served Part B beneficiaries over the past several years. In a letter, the lawmakers demanded that CMS use its authority to end the aggressive dunning of pharmacies for full-price reimbursements for those past services.

The agency, said Baldwin and Stupak, should “immediately instruct all Medicare Part B durable medical equipment Medicare administrative contractors to cease their recoupment activities for services provided and billed in good faith by independent pharmacies.”

If successful, the bid by Baldwin and Stupak will end efforts by those contractors to recoup from independent pharmacies the entire cost of supplies -- such as diabetes testing strips -- that were provided to Medicare patients under the Part B program. According to the National Community Pharmacists Association, contractors are trying to extract full payment for supplies provided by pharmacies as far back as 2006, “despite Medicare Advantage and Home Health Agency bearing responsibility for the payment discrepancy.”

The issue has raised a simmering dispute between retail pharmacy and the federal government. It was raised earlier this year in a joint letter to CMS from the National Community Pharmacists Association, the National Association of Chain Drug Stores, and the National Alliance of State Pharmacy Associations. In a statement Thursday, NCPA EVP and CEO Bruce Roberts praised Baldwin and Stupak “for their leadership on this issue” and accused DME contractors of "being intrusive and unrealistic in demanding pharmacies go back several years to account for the supposed overpayment of Medicare Part B supplies."

“Either patients were getting Part B supplies in the middle of a prescription cycle before they signed up for an MA or HHA, or the patients got the Part B supplies while CMS was processing their application for MA or HHA coverage,” Roberts said. “In either scenario the fault does not lie with pharmacists. Part B claims do not happen in the rapid-fire, coordinated fashion of other programs like Medicare Part D. Instead, pharmacists must rely on getting information from their patients concerning any changes to their prescription drug coverage, which can be confusing and cause further delays."

“That's why the DME contractors need to target MA or HHA in their collection efforts and not the pharmacists,” said NCPA’s top executive, who is retiring later this month after nearly nine years at the organization’s helm.

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