WSJ says insurers kept $9 billion from Medicare

by NCPA | Jan 07, 2019

According to a Wall Street Journal investigation, reported this past Friday, health insurers kept a whopping $9.1 billion in excess payments from Medicare in the years 2005-2016 by inaccurately estimating the prescription drug benefits they proposed to offer to beneficiaries. The article says its investigation is further evidence that the lack of transparency in U.S. health care is driving up spending. "That's the understatement of the decade," says NCPA CEO Douglas Hoey. "Billions of dollars may be a drop in the bucket to these mega-corporations, but it's a huge number to taxpayers. That's more than enough money to pay for eliminating retroactive pharmacy DIR fees – which may be a pawn in contributing to the excess payments to health insurers. The pharmacy payment model is broken and must be rebuilt. This extraordinary story of re-direction of taxpayer funds to just a few corporations is only the latest example. Congress and CMS simply must hold PBM corporations accountable and end this misuse of taxpayer dollars." Note: A WSJ subscription is required in order to access the actual story.