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PCMA: Independent Drugstore Lobby's 'Prompt Pay' Agenda Could Cost Medicare $3.3 Billion Over the Next Decade

Puts Funding of Other Medicare Providers at Risk

WASHINGTON, March 26 /PRNewswire-USNewswire/ --- Legislation that would make Medicare prescription drug plans (PDPs) pay drugstores twice as fast as Medicare pays other providers could cost the program and its beneficiaries at least $3.3 billion over the next decade according to a new study by PricewaterhouseCoopers (PwC) that was commissioned by the Pharmaceutical Care Management Association (PCMA).

"The increased cost of making Medicare PDPs pay retailers twice as fast as doctors and hospitals are paid will almost certainly be financed at the expense of Medicare providers and beneficiaries," said PCMA President and CEO Mark Merritt. "In a pay-go world, this would essentially be a wealth transfer from rural providers, Medicare Advantage plans, Skilled Nursing Facilities, beneficiaries, and others to independent drugstores."

Currently, Medicare PDPs pay pharmacy claims within 30 days, a standard consistent with Medicare Parts A & B, the federal employees' health plan, and the private sector. The 30-day payment standard allows plans to batch claims for administrative efficiency and conduct audits to detect fraud and abuse.

*New PwC study available at:

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
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