Navigation Links
Are Bargaining Groups Hired by Independent Drugstores Causing Payment Delays to Pharmacies?
Date:9/6/2007

PCMA Reaffirms PBMs Paying Clean Claims Within 30 Days

WASHINGTON, Sept. 6 /PRNewswire-USNewswire/ -- Reaffirming that its member companies are paying clean Medicare Part D claims to pharmacies within 30 days, the Pharmaceutical Care Management Association (PCMA) today questioned whether independent drugstore bargaining organizations known as PSAOs could be a factor in late payments to pharmacies.

More than half of America's independent pharmacies hire Pharmacy Service Administration Organizations (PSAOs) to centralize and streamline the following kinds of functions:

-- Collectively bargain with pharmacy benefit mangers (PBMs) to get

favorable terms;

-- Acquire rebates from drug companies; and

-- Process claims/billing information on behalf of independent

pharmacies.

-- In these cases, while the pharmacy sends claims directly to the

PBM, it requires the PBM to send reimbursements to the PSAO.

-- After the PSAO receives the reimbursement from the PBM, it then

pays the pharmacy.

-- This middle step, which occurs at the request of the pharmacy,

could be causing any delays that might be occurring.

"One factor that may be overlooked by the independent drugstore lobby is that their own bargaining groups--PSAOs--could be slowing down payments," said PCMA President & CEO Mark Merritt. "When a PSAO is involved," Merritt added, "there is no guarantee that claims paid promptly by PBMs aren't getting held up by PSAOs. Since so many independent pharmacies use PSAOs, we'd hope that any study of payment practices thoroughly examines their role."

While generating deeper-than-expected discounts for beneficiaries on their necessary prescription medicines, PCMA member companies are also paying all clean claims within 30 days. The 30-day pharmacy claims timeframe is a standard consistent with physician and hospital claims in Medicare Parts A & B, the Federal Employees Health Benefits Plan (FEHBP), and 43 states. Last year, a survey from the Centers for Medicare & Medicaid Services (CMS) found that 18 of the top 20 Medicare prescription drug plans (PDPs) were paying pharmacy claims on a twice-a-month billing cycle of 15 days or less. Reducing the payment cycle would increase costs by creating a new set of administrative burdens for Part D sponsors without providing any corresponding benefit to America's seniors.

"Pharmacists deserve the same 30-day payment schedule that Medicare physicians and hospitals have. We certainly hope that independent pharmacies will evaluate the role of their own PSAOs to determine if reforms can be made there to speed the process along," said Merritt.

Medicare PDPs and the proven pharmacy benefit management tools they utilize are saving beneficiaries and Part D $693 billion over the 2008 to 2017 period, including $43 billion in reduced prescription drug costs in 2008 alone, according to a recent analysis from PricewaterhouseCoopers (PwC).

PCMA is the national association representing America's pharmacy benefit managers (PBMs), which administer prescription drug plans for more than 210 million Americans with health coverage provided through Fortune 500 employers, health insurance plans, labor unions, and Medicare Part D.


'/>"/>
SOURCE Pharmaceutical Care Management Association
Copyright©2007 PR Newswire.
All rights reserved

Related medicine news :

1. No link between blood groups and prostate cancer
2. Religious groups overcome objections to cervical cancer vaccines
3. Yogic Moments: Age Old Yoga, Benefits All Age Groups
4. Plastic Surgery Is Primetime among Ethnic Groups
5. Study Finds Online Support Groups Emotionally Benefit Women Suffering From
6. Specialist Services Can Help Ethnic Groups To Tackle Alcohol Misuse
7. Distinct Support Services Needed, To Resurrect Ethnic Groups from Alcohol Abuse
8. NGOs and Various Groups Come Together To Address the Issues on AIDS
9. U.S: Prize for the best hearing category (ethnic groups) goes to…. Non-Hispanic Blacks
10. Anti-Obesity Groups Criticize Response of Medical Professionals
11. Hospitals Appeal to Citizen Groups to Rush Doctors, Paramedicals
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/25/2016)... ... ... On Friday, June 10, Van Mitchell, Secretary of the Maryland Department of Health ... of their exemplary accomplishments in worksite health promotion. , The Wellness at Work Awards ... at the BWI Marriott in Linthicum Heights. iHire was one of 42 businesses to ...
(Date:6/24/2016)... Michigan (PRWEB) , ... June 24, 2016 , ... June ... about the dangers associated with chronic pain and the benefits of holistic treatments, ... individuals who are suffering with Sickle Cell Disease. , Sickle Cell Disease (SCD) is ...
(Date:6/24/2016)... San Francisco, CA (PRWEB) , ... June 24, ... ... at CitiDent, is now offering micro-osteoperforation for accelerated orthodontic treatment. Dr. Cheng has ... , self-ligating Damon brackets , AcceleDent, and accelerated osteogenic orthodontics. , ...
(Date:6/24/2016)... ... June 24, 2016 , ... EB ... Decision Making in Emergency Medicine conference in Ponte Vedra Beach, FL. The awards ... in Emergency Medicine Practice and Pediatric Emergency Medicine Practice. , “With ...
(Date:6/24/2016)... ... June 24, 2016 , ... National recruitment firm Slone Partners ... extensive sequencing and genomics experience, as Vice President of North American Capital Sales at ... responsible for leading the sales team in the commercialization of the HTG EdgeSeq system ...
Breaking Medicine News(10 mins):
(Date:6/23/2016)... 2016 Research and Markets has announced ... report to their offering. ... a favourable commercial environment for MedImmune to enter. The US ... will serve to drive considerable growth for effective anti-influenza medications. ... cap sales considerably, but development is still in its infancy. ...
(Date:6/23/2016)... and INDIANAPOLIS , June 23, ... a Lilly Diabetes Tomorrow,s Leaders Scholarship is any indication, ... winners, announced today online at www.diabetesscholars.org by ... 1 diabetes stand in the way of academic and ... the Foundation,s scholarship program since 2012, and continues to ...
(Date:6/23/2016)...  Guerbet announced today that it has been named ... . One of 12 suppliers to receive ... support of Premier members through exceptional local customer service ... to lower costs. ... outstanding customer service from Premier," says Massimo Carrara ...
Breaking Medicine Technology: