NCPA Asks CMS to Prevent Medicare Part D Plans From Exploiting Prompt Pay Provisions

Alexandria, Va. - March 03, 2010

The National Community Pharmacists Association (NCPA) today sent a letter asking the Centers for Medicare and Medicaid Services (CMS) to instruct Medicare Part D plan providers to stop the "improper and illegal imposition of extraneous fees and charges on Part D network pharmacies" that have been reported to NCPA since new "prompt pay" provisions took effect January 1, 2010. The Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 requires Part D plans to pay pharmacies within 14 days of the submission of clean prescription drug claims, which in turn should be paid electronically if requested by the pharmacies. 

The letter states that many Part D plans are "finding ways to charge new fees to pharmacies, seemingly as a means of financially recouping the loss from the 'float' they enjoyed from holding onto pharmacies' money for long periods." NCPA member pharmacies are reporting failures to send necessary remittances, claims reconciliation issues, new prescription transaction fees, electronic funds transfer fees, failure to notify or honor electronic fund transfer options, and requiring electronic remittances for electronic fund transfers. NCPA contends CMS is not constrained by the "non interference" clause in the Medicare Modernization Act that created the Part D program in providing written guidance to Part D plans regarding these issues. 

"This year community pharmacies have seen a flurry of unexpected, dubious, additional fees and charges from a number of Medicare Part D plans that appear to violate federal prompt pay requirements," said Bruce T. Roberts, RPh, NCPA executive vice present and CEO. "It's imperative that CMS use its authority to end these practices that fly in the face of Congress' original intent behind the legislation." 

"We appreciate those plans that have taken steps to comply with both the spirit and the letter of the prompt pay law," Roberts added. "Unfortunately, other Part D plans seem to be using financial gimmicks to further line their pockets at the expense of community pharmacies already grappling with declining reimbursements." 

A complete copy of the letter can be read here

The National Community Pharmacists Association (NCPA®) represents America's community pharmacists, including the owners of more than 22,700 independent community pharmacies, pharmacy franchises, and chains. Together they represent an $88 billion health-care marketplace, employ over 65,000 pharmacists, and dispense over 40% of all retail prescriptions. To learn more go to www.ncpanet.org or read NCPA's blog, The Dose, at http://ncpanet.wordpress.com.

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