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Plainfield, NJ -- U.S. Rep. Frank Pallone, Jr. (D-NJ), local pharmacists, independent pharmacy owners, and New Jersey elected officials joined together today at Rapps Pharmacy in Plainfield to discuss the flawed Medicare Prescription drug benefit and the impact it is having on community pharmacists.
The Medicare prescription drug benefit, which took effect on January 1, has had damaging effects on senior citizens who are unable to access their much-needed medications, and who have had difficulty understanding the complex plans. However, pharmacists and independent pharmacy owners have also faced serious challenges brought about by the poor implementation of the new Medicare plan.
"In addition to working extended hours, many pharmacists have absorbed the cost of beneficiaries’ medications in the hopes of being reimbursed once the problems with the system are resolved," Pallone said. "Some pharmacists actually had to take out loans in order to keep their pharmacy doors open while they wait to be reimbursed. Others cannot afford to bear the financial burden and are forced to deny beneficiaries their prescriptions."
Adding to their financial burden, pharmacists do not receive a prompt payment for the prescriptions they dispense under the new plan. Previously, under State Medicaid programs, participating pharmacies were reimbursed twice a month for covered prescriptions. Now, under the new Medicare prescription drug program, private drug plans have between 60-90 days to reimburse a pharmacist for a drug dispensed to a dual eligible (a beneficiary eligible for both Medicare and Medicaid). This leaves pharmacists responsible for all the costs associated with dispensing the drugs.
"This is particularly difficult for pharmacists located in low-income areas who serve many dual eligible clients, like Rapps Pharmacy here in Plainfield," Pallone noted. "These pharmacists have been left holding the bag for the failures of this Republican plan."
Pallone, a senior member of the House Energy and Commerce Committee, said he would investigate this matter further and inquire as to whether the Administrator of the Centers for Medicare and Medicaid Services (CMS) has the authority to issue a "prompt pay regulation" that would mandate private insurers reimburse pharmacists in a more timely fashion. The New Jersey congressman said that if they do not have the statutory authority, he will introduce legislation that will mandate a more prompt payment for our community pharmacists who should not be liable for the confusing mess caused by the Bush Administration's poor planning.
Independent pharmacies are also facing the issue of "co-branding" under the new prescription drug plan, which puts them at a unique disadvantage. The Bush administration has allowed the private drug plans and large chain pharmacies such Wal-Mart and Walgreen's to "co-brand", or collaborate on marketing materials that are sent to beneficiaries. For example, a beneficiary's membership card often has the name of the prescription drug plan on it and the chain that it has co-branded with.
As a result, many beneficiaries are under the assumption that they can only get their prescription drugs at those pharmacies. They are unaware that in most cases, their community pharmacist, who they have been going to for years, also participates in the prescription drug plan's preferred provider network.
"Once again, this goes to show that this bill was not developed for those who need the most help," Pallone said. "It was developed to benefit the large insurance companies and the pharmaceutical industry, not our most vulnerable citizens or those who serve them."
Pallone opposed the Republican prescription drug law when it came up for a vote two years ago because it did not provide a defined benefit to seniors within the Medicare system. He instead supported legislation that would create a drug plan provided directly by Medicare rather than private insurance companies and allow the Secretary of Health and Human Services to negotiate lower prescription drug prices for Medicare beneficiaries.
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