Capito introduces bipartisan bill to shield community pharmacies from retroactive fees

Bipartisan legislation introduced by U.S. Sen. Shelley Moore Capito (R-WV) on Tuesday would prevent Medicare Part D plan sponsors from retroactively reducing payments on accurate reimbursement claims submitted by pharmacies.

The Improving Transparency and Accuracy in Medicare Part D Drug Spending Act, which was introduced by Capito and U.S. Sen. Jon Tester (D-MT), aims to ensure that community pharmacies are able to continue serving Medicare beneficiaries.

“Community pharmacies that serve rural communities face similar challenges to other small businesses with limited access to capital,” Capito said. “The uncertainty in Medicare Part D drug pricing has also become a major concern for community pharmacies. By stabilizing the amount of money these pharmacies pay for prescriptions, more patients will have access to the medications they need. The Improving Transparency and Accuracy in Medicare Part D Drug Spending Act will help solve this growing problem.”

Congress approved a measure in 2008 that required pharmacies to be paid promptly – within 14 days – for accurate Medicare Part D reimbursement claims to ensure that community pharmacies would be able to continue serving beneficiaries.

Medicare Part D sponsors and pharmacy benefit managers, however, recently began to assess retroactive fees on pharmacists weeks or months after a prescription was filled.

“I hear it more and more during my travels across Montana, the market for prescription drugs is broken and we need to act to hold drug companies and middlemen accountable,” Tester said. “This bipartisan legislation will do just that and ensure excessive profits aren’t being extracted at the expense of the community and rural pharmacies that serve America’s seniors.”

The measure would prohibit retroactive fees from being assessed on accurate claims, and would provide more transparency in drug pricing for Medicare Part D beneficiaries.