ALEXANDRIA, Va. The National Rural Health Association is backing three legislative solutions currently in the Senate and House of Representatives that would remove steps blocking the financial viability of community pharmacies who endure slow reimbursement of Medicare Part D claims, pending cuts to Medicaid generic prescription drugs, and an inability to effectively bargain for fair contracts with the pharmacy benefit managers who administer drug plans.
The NRHA supports H.R.1474, the Fair and Speedy Treatment of Medicare Prescription Drug Act of 2007, and S.1954, the Pharmacy Access Improvement Act of 2007. These similar bills fix the slow pharmacy reimbursement of Medicare Part D prescription drug claims by PBMs, which cause cash flow problems for community pharmacies that force loans in the tens to hundreds of thousands of dollars to be taken out. The bills require complete and accurate Part D claims submitted electronically to be paid within 14 days by electronic funds transfer, and paper claims within 30 days.
The House and Senate are also considering bills tackling the Centers for Medicare and Medicaid Services’ Medicaid generic prescription drug pharmacy reimbursement formula based on what pharmacy groups are calling a “flawed” average manufacturer price. While the approaches are a bit different, NRHA endorses the inherent goal of each bill: to limit the damage AMP would have on community pharmacies and the patients they serve.
According to a Government Accountability Office study, community pharmacies, on average, will be reimbursed 36 percent below their acquisition costs for these drugs when the change is fully implemented in January 2008. H.R.3140, the Saving Our Community Pharmacies Act, establishes a new and fair pharmacy reimbursement benchmark reflective of what the actual retail costs are and includes provisions to drive generic drug utilization that increase taxpayer savings,. while S.1951, the Fair Medicaid Drug Payment Act of 2007 is focused on improving the AMP formula criteria for determining the averages and raises the maximum amount of potential reimbursement.
In addition, the NRHA supports the companion bills in the House and Senate—H.R. 971, the Community Pharmacy Fairness Act of 2007, and S.2161, which has the same title. These bills target the continuing problem of community pharmacies being offered take-it-or-leave-it contracts by the PBMs. They create a narrow exemption to current antitrust laws that allows community pharmacists to negotiate contracts as a group, which is essentially the arrangement under which the large, publicly held chain drug stores already operate.
“The National Rural Health Association’s endorsements of these common-sense bills is vital to presenting a united front of organizations that Congress will respond to in the near future,” said Charles Sewell, senior vice president of government affairs for the National Community Pharmacist Association. “The message should be loud and clear: if these bills are not acted upon, Congress will bear responsibility for the hardships and lack of services that community pharmacy patients will experience.”