Medicare Part D sponsors and pharmacy benefit managers (PBMs) would be prohibited from retroactively reducing payments on accurate reimbursement claims under bipartisan legislation reintroduced by U.S. Sen. Shelley Moore Capito (R-WV).
The Improving Transparency and Accuracy in Medicare Part D Drug Spending Act aims to increase prescription drug pricing transparency and to eliminate uncertainties that make it difficult for community pharmacies to serve Medicare beneficiaries.
“Community pharmacies are important to our small towns and rural areas, and must remain open and accessible to Medicare patients,” Capito said. “The uncertainty in Medicare Part D drug pricing has posed many challenges for these small operations, but our bill will help stabilize the prices community pharmacies pay for prescriptions and allow more patients to access the medications they need.”
Congress mandated in 2008 that accurate Medicare Part D reimbursement claims be paid within 14 days. Medicare Part D sponsors and PBMs, however, have imposed retroactive fees on pharmacists, sometimes months after a prescription was filled.
In addition to eliminating retroactive fees, the bill would promote drug pricing transparency by providing more accurate pricing information online for Medicare beneficiaries to review.
“Seniors are being forced to pay more for prescription drugs than ever before, this is a major problem and we have to hold everyone accountable,” U.S. Sen. Jon Tester (D-MT), who reintroduced the bipartisan bill with Capito. “No one should raise prices and grow profits at the expense of seniors and the medical providers and pharmacies that serve rural families.”