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Study Indicates Strong Consumer Preference to Fix Medicare Part D and Medicaid Flaws Threatening Access to Prescription Drugs
Date:12/18/2007

nt of Medicare Part D prescription drug claims by PBMs cause cash flow problems for community pharmacies that force them to take out loans in the tens to hundreds of thousands of dollars range. The bills - H.R.1474, the Fair and Speedy Treatment of Medicare Prescription Drug Act of 2007, and S.1954, the Pharmacy Access Improvement Act (PhAIM) of 2007?require complete and accurate Part D claims submitted electronically be paid within 14 days by electronic funds transfer, and paper claims within 30 days.

In addition, the survey found 78 percent thought it was unfair that "under the new rule, pharmacies that participate in the Medicaid program would have to sell generic drugs at a loss." The survey also found 78 were less likely to support the new rule because "many community pharmacies will not be able to continue servicing Medicaid patients, including children," especially after they learn "over 28 million children in the U.S. get prescription medications paid for by the Medicaid and account for over half of the beneficiaries." Furthermore, the survey found 74 percent support legislation that would reimburse pharmacy more fairly.

The Centers for Medicare & Medicaid Services' (CMS) Medicaid generic prescription drug pharmacy reimbursement formula is based on a flawed Average Manufacturer Price (AMP). According to a Government Accountability Office study, on average community pharmacies will be reimbursed at least 36 percent below their acquisition costs when the change is fully implemented in early 2008. While the legislative solutions are slightly different in the House and Senate, the goal of limiting the damage AMP would have on community pharmacies is the same. H.R.3140, the Saving Our Community Pharmacies Act, establishes a new and fair pharmacy reimbursement benchmark reflective of what the actual retail costs are and includes provisions to drive generic drug utilization that increase taxpayer savings. While S.1951, the Fair Medicaid Drug Payme
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SOURCE National Community Pharmacists Association
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