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PCMA: 'Protect Your Pharmacy Week' Should Focus on Safeguarding Part D Anti-Fraud Tools
Date:4/10/2008

New Survey and Ad Highlight Fraud, Waste, and Abuse Problem

Merritt: 'Small Pharmacies Can Be Especially Vulnerable'

WASHINGTON, April 10 /PRNewswire-USNewswire/ -- A new survey of experts responsible for detecting and preventing pharmacy fraud, waste, and abuse in Part D finds that proposals requiring drugstores to be paid twice as fast as other Medicare providers would increase costs and make it more difficult to fight fraud, waste, and abuse, the Pharmaceutical Care Management Association (PCMA) said today. In addition to the new survey, PCMA is also launching a print advertising initiative that highlights how "finding the bad apples isn't easy" in detecting fraud, waste, and abuse and that proposals mandating "prompt pay" would make it even tougher.

"'Protect Your Pharmacy Week' is a good time to focus on safeguarding the tools needed to fight increasingly sophisticated and aggressive fraud tactics. Finding the 'bad apples' isn't always easy and small pharmacies can be especially vulnerable," said PCMA President and CEO Mark Merritt. "Part D plans employ a variety of state-of-the-art techniques when working with pharmacies and other stakeholders to combat fraud, waste, and abuse. Making plans pay drugstores twice as fast as other Medicare providers would increase costs and make fighting fraud, waste, and abuse more difficult."

Survey findings include:

-- Pharmacy Fraud, Waste, and Abuse Is Costly: Approximately 1 percent of prescription costs are likely due to fraud, waste, or abuse. This amounts to hundreds of millions of dollars in unnecessary costs for the Medicare Part D program and its beneficiaries.

-- Part D Plans Use Advanced Techniques to Combat Fraud, Waste, and Abuse: Part D plans use sophisticated software and auditing techniques to identify problematic prescription claims. Most plans screen for fraud, waste, and abuse both before and after a claim is paid. Problem claims can often be detected
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SOURCE Pharmaceutical Care Management Association
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