Capito bill aims to protect pharmacies that serve Medicare beneficiaries

U.S. Sen. Shelly Moore Capito (R-WV) has taken the lead in reintroducing legislation that would ensure community pharmacies have the financial certainty needed to continue serving Medicare beneficiaries.

The bipartisan Improving Transparency and Accuracy in Medicare Part D Drug Spending Act, S. 988, was introduced by Sen. Capito with U.S. Sen. Jon Tester (D-MT) on April 2. The bill, which is being considered by the Senate Finance Committee, would prohibit Medicare Part D prescription plan sponsors and pharmacy benefit managers from retroactively reducing payments on accurate reimbursement claims submitted by pharmacies.

“It is essential patients have access to the medications and information they need from those they trust,” Sen. Capito said. “Community pharmacies are important to our small towns and rural areas and must remain open and accessible to Medicare patients.” 

Congress had required in 2008 that pharmacies be paid within 14 days in order to ensure accurate Medicare Part D reimbursement claims. Fast payments can help local pharmacies meet their financial obligations.

However, recently Medicare Part D sponsors and pharmacy benefit managers have begun imposing several retroactive fees on pharmacists that are collected sometimes months after a prescription was filled, Sen. Capito’s office said.

988 would prohibit those types of fees from being imposed. The bill would also provide greater drug pricing transparency for Medicare Part D beneficiaries who would have access to more accurate information available online. 

“… Just like any small business, these hospitals, clinics, and pharmacies need stability and certainty to survive,” Sen. Tester said. “That’s why we’re introducing this bipartisan bill once again, to ensure neighborhood pharmacies aren’t subjected to the financial whims of medical bureaucrats and middlemen.”