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NCPA Statement on Sen. Baucus' Medicare Bill Inclusion of Solutions for Medicare and Medicaid Reimbursement Problems

ALEXANDRIA, Va., June 9 /PRNewswire-USNewswire/ -- Sen. Max Baucus (D-MT), chair of the Senate Finance Committee, has introduced a $20 billion Medicare bill that includes pharmacy-related provisions to provide prompt payment of Medicare Part D prescription drug claims and delay the implementation of Medicaid reimbursement cuts for generic prescription drugs. In response Bruce Roberts, RPh, executive vice president and CEO of the National Community Pharmacists Association (NCPA), issued the following statement:

"Chairman Baucus has included two provisions in his Medicare bill that will assure access for the patients of America's 23,000 community pharmacies. Our members and their patients are counting on these provisions to become law to assure their access to prescription drugs. The first provision ends the deliberately slow payment of Part D claims that force community pharmacies to maintain cash flow by taking out huge loans; while the second one delays the implementation of a fundamentally-flawed Medicaid reimbursement formula that forces community pharmacies to be reimbursed below actual generic prescription drug cost."


Prompt Payment

In 2006, the first full year of Medicare Part D's implementation, five percent of America's community pharmacies permanently closed their doors. Ever since Part D's implementation on Jan. 1, 2006, community pharmacies have experienced cash-flow problems that have necessitated the need for loans in the tens to hundreds of thousands dollars. The pharmacy benefit managers (PBMs) responsible for administering the various Part D plans are paid by the government in advance, and could help remedy the problem, but rather than paying promptly, they choose to earn interest on the government's payment, and pay pharmacies late for their services.

Average Manufacturers Price

The new Medicaid reimbursement formula is based on the Average Manufacturer Price (AMP) from the 2005 Deficit Reduction Act's mandate to find $8.4 billion in Medicaid cuts, 90 percent coming from pharmacy reimbursement--although pharmacy only represents 2 percent of Medicaid spending. A Government Accountability Office Study from December of 2006 found that on average, pharmacies would get reimbursed 36 percent below cost. This objective was achieved by including several pricing categories that push down the typical acquisition costs to dispense drugs below what community pharmacies pay. The final rule was issued on July 17, 2007 and the implementation process was slated to end January 30, 2008. To stop this from taking effect, NCPA and the National Association of Chain Drug Stores (NACDS) filed a successful lawsuit that stopped the implementation from occuring in late 2007. The legal process is still ongoing.

The National Community Pharmacists Association, founded in 1898, represents the nation's community pharmacists, including the owners of more than 23,000 pharmacies. The nation's independent pharmacies, independent pharmacy franchises, and independent chains dispense nearly half of the nation's retail prescription medicines. To learn more go to

SOURCE National Community Pharmacists Association
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