This is the ad that the National Community Pharmacists Association will publish in some of the capital’s newspapers in favor of a bill that will require prompt payment for Medicare prescription drug reimbursement for pharmacies.
NCPA wants lawmakers to require prescription drug plans to reimburse pharmacies for prescriptions no later than 14 days after claims are submitted, Lisa Miller, vice president of public affairs for NCPA, said.
Pharmacy benefit managers plan to fire back and re-run their ads featuring three juicy green apples and a rotten one. "Finding the bad apples isn't this easy ... and 'prompt pay' would make fighting fraud, waste and abuse even tougher," the inside-the-Beltway ad by the Pharmaceutical Care Management Association reads.
PCMA says pharmacy benefit managers need longer than 14 days to detect suspicious billing patterns, monitor pharmacy claims and conduct audits.[1]
Since when do PBM’s conduct audits in 14 days? Even if they pay a fraudulent or abusive transaction (which is a very, very small percentage of the market), they can go back and audit whenever they want! I am receiving audits from 2006 right now and if they find anything they don’t like (something as irrelevant as a comma missing in the address of the prescription), they just reclaim the $200 they paid you for that acne gel you billed them in 2006 and got paid in 30 days (which you had to pay in 7 days in order to get a 15% discount from the wholesaler). You got reimbursed AWP minus 17%, got paid in 30 days, paid the wholesaler in 7 days to get the 15% discount and gave the product for free to your customer because they reclaimed your payment! When doing the math I just think we pharmacists, even though have approved up to Calculus I to get to pharmacy school, don’t even know basic math. How are we even signing these contracts! Now the PBM’s complain that they can’t pay in 14 days because of fraud, please! I hope our congressmen can find the real bad apple in the pharmaceutical industry. (Hint: If you look at the Global Fortune 500 companies you will find them, with billions of dollars in earnings).
[1] Anna Edney, Community Pharmacists Hope to Catch Eyes, Votes With Ad, National Journal's Congress Daily A.M. (May 16, 2008).
