Pharmacists Offer Recommendations to Fight Medicare Part D Waste, Fraud and Abuse



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Alexandria, Va. - October 4, 2011

The National Community Pharmacists Association (NCPA) today provided several recommendations to reduce waste, fraud and abuse in comments submitted to a U.S. Senate Homeland Security and Government Affairs Subcommittee holding a hearing on "Costs of Prescription Drug Abuse in the Medicare Part D Program."

"NCPA and its members remain committed to combating waste, fraud and abuse within federal health care programs, and stand at the ready to assist with these efforts," NCPA told the subcommittee. "It is important for Congress to also focus on the existing waste within and potential savings from how pharmacy benefit managers operate in the Medicare Part D program. In the end, NCPA seeks to partner with the federal government in the right way to generate health care savings, while providing high quality health care to our patients."

NCPA's comments offered the following recommendations to the federal government:

  • Ensure that requirements to use National Provider Identifier (NPI) numbers on Part D claims provide for an adequate transition to avoid inadvertently penalizing pharmacies acting in good faith to serve patients. S. 1251, the Medicare and Medicaid FAST Act, would require that every health care provider obtain and be required to use an individual, not a group, NPI number for prescription claims. However, today prescribers continue to use group NPIs and the policies of Part D plans regarding NPI use vary from plan to plan.
  • Ensure the government receives billions of dollars in manufacturer rebate savings currently retained by pharmacy benefit managers (PBMs) under the Part D program. The U.S. Department of Health and Human Services' Inspector General issued two reports within the past year that collectively found that most PBMs/plan sponsors do not pass on to beneficiaries the full amount of rebates and discounts.
  • Promote the appropriate use of generic prescription drugs. Community pharmacies dispense generic drugs over 10 percent more often than mail order pharmacies, which benefit from brand-name manufacturer rebates. NCPA also cited "automatic shipping" by PBM-owned mail order pharmacies that can leave patients with excess medications, which they consistently dispose of at local community pharmacies.
  • Require Part D plans implement consistent pharmacy audit practices to strengthen fraud protections and focus on true fraud. Pharmacies make up just 0.2 percent of the "excluded providers" banned from Medicare and other federal programs. Yet law-abiding pharmacies are being targeted for auditing and fines that have little or nothing to do with fraud but rather appear to be an effort to increase the profits of PBMs/plan sponsors.

The National Community Pharmacists Association (NCPA®) represents the interests of America's community pharmacists, including the owners of more than 23,000 independent community pharmacies, pharmacy franchises, and chains. Together they represent a $93 billion health-care marketplace, have more than 315,000 employees including 62,400 pharmacists, and dispense over 41% 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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