ALEXANDRIA, Va. — Reps. Doug Collins, R-Ga., and Martha Roby, R-Ala., on Tuesday advocated for community pharmacy with letters addressed to the leaders of the House Energy and Commerce Committee and Ways and Means Committee.
In serving Medicare seniors, community pharmacies should be subject to the same three-year audit review period as hospitals, and not forced to document 10-year-old claims, the Representatives suggested.
“Patients rely on their independent community pharmacists to ensure proper medication use, to guard against drug interactions and to help take advantage of lower-cost generic drugs, where appropriate,” said NCPA CEO Douglas Hoey. “These pharmacists should not face needless distractions to patient care, such as documenting why they filled a prescription a decade ago. We appreciate Reps. Collins and Roby taking the time to not only meet with some of the pharmacy small business owners that they represent, but for also registering their concern with the appropriate committee leaders.”
“A few weeks ago I was back in my district and had the opportunity to visit with several small pharmacy owners and their employees about issues they face and deal with every day," Collins wrote. "It was very concerning for me to hear the struggles and lack of leverage these constituents face when conducting business with large pharmacy benefit managers.”
"One could question why PBMs need 10 years to begin an audit,” Roby suggested. “Precedent for a shorter look-back already exists within the Medicare RAC process.”
She also urged the committees to examine PBM auditing methods, a shorter look-back period and what percentage of funds recouped from pharmacies by auditors are actually returned to the Medicare trust fund. In addition, Rep. Roby expressed concern that “pharmacies are frequently reimbursed below their cost to dispense drugs,” and that PBM payment benchmarks for generic drugs are not updated frequently enough to avoid “artificially decreasing pharmacy drug reimbursements.”
Twenty-nine states have enacted legislation setting common-sense standards for pharmacy audits, NCPA noted. The Medicare Prescription Drug Program Integrity and Transparency Act (S. 867), introduced by Sens. Mark Pryor, D-Ark., and Jerry Moran, R-Kan., would implement similar reforms at the federal level, ensure that legitimately recouped funds are passed through to the plan sponsor (such as Medicare) and ban 10-year-old audits.