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It's No Joke: Independent Drugstores Want Congress to Help Them Raise Prescription Drug Costs
Date:5/24/2011

n (NHCAA), the leading national organization focused exclusively on combating health care fraud, also warns against the kind of legislative proposals promoted by the independent pharmacy lobby. The paper, the "Seven Guiding Principles for Policymakers," seeks to address the estimated $70 to $234 billion in annual financial losses resulting from fraud throughout the health care system and warns policymakers to avoid policies that could undermine fraud fighting efforts, including:

  • Policies that undermine authority across Medicare to suspend payments when there is suspicion of fraud. The ability to stop fraud before paying a claim is more effective and more efficient than relying on paying first and then chasing after claims that are later found to be fraudulent. Congress should extend to Medicare Part D and independent drugstores the recently enacted statutory authority Congress provided in Medicare Parts A and B to suspend payment to health care providers upon a credible allegation of fraud, waste, or abuse.
  • Policies that reduce payers' time to verify pharmacy claims before payment ("Prompt Pay" policies). NHCAA states: "if claims are not rushed through the payment process, auditors and investigators will have more opportunities to detect attempts at fraud before they come to fruition." So-called "prompt pay" laws in Medicare Part D that mandate rapid payment to independent pharmacies reduce the time available to detect pharmacy fraud, waste, and abuse.
  • Policies that make payers partner with pharmacies that are banned from federal programs ("Any Willing Pharmacy" policies). Legislation that would force plans to include in their networks pharmacies that have been banned from federal programs "runs counter" to preventing fraud, according to NHCAA. This low bar would allow admission for pharmacists "even if they have records of harmful prescript
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SOURCE Pharmaceutical Care Management Association
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