Cochran bill aims to speed up drug reimbursement

Published 5:00 am Wednesday, April 26, 2006

U.S. Sen. Thad Cochran recently introduced a bill he hopes willensure community pharmacists receive prompt reimbursement frominsurance companies.

The bill comes in response to an outcry from pharmacists afterMedicare Part D, a new prescription drug bill, took effect afterthe first of the year. Although lawmakers consider Medicare Part Dto be a success, many community pharmacists have felt a financialstrain, as reimbursements from Prescription Drug Plans (PDPs) havebeen slow to materialize.

Under the current system, Medicare beneficiaries bring theirprescription into their local pharmacists, pay a discounted priceand receive their medication. The pharmacists then submit theirclaim to the PDP.

“I may not get the reimbursement for 30, 60, or 90 days later,”said Roberts Watts, of Robert Watts Pharmacy. “Some pharmacists arehaving to borrow money to take orders.”

Frustrations such as these have prompted Cochran to introduceThe Pharmacists Access and Recognition in Medicare (PhARM) act.

With PhARM, Cochran hopes to ensure pharmacists have access totheir due reimbursement from PDPs. Secondly, he hopes the bill willprovide pharmacists with the recognition of their ability toprovide critical information to patients.

“Insurance companies will be required to reimburse pharmacistswithin 14 days with this bill, ” said Margaret Wicker, presssecretary for Cochran. “Additionally, PDPs will be mandated tonotify pharmacies within 10 days if a claim is problematic.”

With as much as 75 percent of their revenue coming from thirdparty reimbursements, pharmacists like Watts see this as a muchneeded improvement to Medicare Part D.

“Community pharmacists have been instrumental in theimplementation of the Medicare prescription drug program,” said Dr.Leigh Ann Ross, Health Fellow in Cochran’s Office. “The PhARM Actrecognizes the cash flow challenges many pharmacies have faced andensures that payments from the health plans will not be delayed.This will allow local, community pharmacies to continue to providequality care for Medicare beneficiaries.”

With PhARM, lawmakers also hope to ensure that pharmacists arerecognized as capable providers of Medication Therapy Management(MTM), educational services that help patients know whichmedications and which drug plans are best for them. PhARM wouldcall for a two-year program encouraging the use of pharmacists inthis role.

Lawmakers believe the measures will not only ensure theexistence of community pharmacists, but will ensure that patientsreceive the care they need from a pharmacist in theircommunity.

“We want to make sure that our local community pharmacists don’tgo out of business because they provide access for the patient toboth information and the prescription drugs they need,” Rosssaid.

Pharmacists like Watts hope that changes come sooner rather thanlater.

“It makes you want to pursue other interests,” he said.

Watts was unaware of PhARM, but he said he hopes lawmakers willprovide relief soon.