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University of Texas Study Details Lengthy Payment Delays for Medicare Part D Prescription Drug Claims, Confirming Need for Legislative Fix
Date:9/6/2007

ALEXANDRIA, Va., Sept. 6 /PRNewswire-USNewswire/ -- The University of Texas at Austin's Center for Pharmacoeconomic Studies released a study today called the "Length of Prescription Drug Payment Times by Medicare Part D Plans." It provides incontrovertible evidence of the slow reimbursement pharmacies have endured with Medicare Part D prescription drug claims. The study demonstrates the need for the Senate and House to pass S.1954, the Pharmacy Access Improvement Act (PhAIM) of 2007, and H.R.1474, the Fair and Speedy Treatment (FAST) of Medicare Prescription Drug Claims Act of 2007. The bills are designed to end the detrimental payment practice that threatens our frontline health care practitioners and their patients.

"This is the first study I know of that thoroughly examines the payment times for Medicare Part D prescription drug claims data," said Kristen Richards, PhD, RPh, research associate at the University of Texas at Austin's Center for Pharmacoeconomic Studies. "It clearly shows that the community pharmacies in this study did not receive payment for a substantial proportion of their 2006 Medicare Part D claims within a 30-day time period."

The study calculated the time between when pharmacies submit claims and when pharmacies received payment for those claims in 2006. The data are of approximately 3 million Part D claims, with over 600,000 coming from community pharmacies and 2.3 million coming from chain drug stores. There were 145 community pharmacies and 17 chain drug firms whose records were examined. Importantly, the study's data represents the optimum payment scenario for pharmacies since the examined claims were both submitted and paid electronically, as opposed to the majority of claims that are paid by mail, which create an even longer payment time.

The study found that 50.0 percent of community pharmacy claims were paid more than 30 days after adjudication, including 17.1 percent where payment took over 60 days. <
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SOURCE National Community Pharmacists Association
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