NCPA Supports Reps. Baldwin and Stupak in Their Call to End Overly Aggressive Recoupment Efforts for Pharmacy Medicare Part B Services

Alexandria, VA - June 17, 2010

 

U.S. Representatives Tammy Baldwin (D-WI) and Bart Stupak (D-MI) recently sent a letter to the Centers for Medicare and Medicaid Services (CMS) asking the federal agency to, "immediately instruct all Medicare Part B Durable Medical Equipment (DME) Medicare Administrative Contractors (MAC) to cease their recoupment activities for services provided and billed in good faith by independent pharmacies." The contractors want recoupment from the pharmacy for the entire costs of the supplies, like diabetes testing strips, provided to Medicare patients from as far back as 2006, despite Medicare Advantage (MA) and Home Health Agency (HHA) bearing responsibility for the payment discrepancy. 

The issue was raised earlier this year in a joint letter to CMS from the National Community Pharmacists Association (NCPA), National Association of Chain Drug Stores (NACDS), and National Alliance of State Pharmacy Associations (NASPA). In response to Baldwin and Stupak's letter, Bruce T. Roberts, RPh, NCPA executive vice president and CEO, issued the following statement: 

"Pharmacists in Wisconsin, Michigan and across the country should applaud Representatives Tammy Baldwin and Bart Stupak for their leadership on this issue. DME contractors are being intrusive and unrealistic in demanding pharmacies go back several years to account for the supposed overpayment of Medicare Part B supplies. 

"Either patients were getting Part B supplies in the middle of a prescription cycle before they signed up for an MA or HHA; or the patients got the Part B supplies while CMS was processing their application for MA or HHA coverage. In either scenario the fault does not lie with pharmacists. Part B claims do not happen in the rapid-fire, coordinated fashion of other programs like Medicare Part D. Instead, pharmacists must rely on getting information from their patients concerning any changes to their prescription drug coverage, which can be confusing and cause further delays. 

"That's why the DME contractors need to target MA or HHA in their collection efforts and not the pharmacists. Representatives Baldwin and Stupak's call for CMS to use its authority to have the contractors end this practice is the right solution. We hope CMS will heed their advice and act accordingly. This will allow pharmacists to continue doing what they do best: care for their patients without getting caught up in a bureaucratic nightmare."

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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