Pharmacists say Medicare Part D volume does them no favors
Pharmacist Brian Ambrefe often spent two and a half to three hours on hold on the phone to pharmacy benefit management firms in the early days of January, trying to advocate for his customers who were new enrollees to Medicare Part D. Hold times have shortened somewhat since then, says Ambrefe, who co-owns Village Pharmacy in Lynnfield. But late last month, he said he expected April 1 to be a repeat of the problems experienced beginning Jan. 3. Now that the 90-day grace period that allowed off-formulary prescriptions to be reimbursed has ended, Medicare Part D enrollees may once again be scrambling as they try to refill their previous prescriptions.
Among the bigger concerns - as the initial enrollment confusion abates - is that the payment process continues to be exceedingly slow, and the increased customer volume the pharmacists were assured they’d get isn’t easy to administer.Because information from the hundreds of prescription drug plans isn’t standardized, it’s difficult to determine whether a drug is a formulary drug or not. It’s also hard to tell whether there’s a prior authorization procedure or what the patient or doctor has to go through to get an exclusion from formulary restrictions. And there’s no consistent form for the PDPs to use. The federal Center for Medicaid Services has proposed a universal form but the prescription drug plans have yet to accept them - or to tell CMS that they will, Ambrefe said recently.
David Benoit, vice president of customer care for Framingham-based Northeast Pharmacy Service Corp., says the rocky Medicare Part D launch has cost the nation’s pharmacies about a half-billion dollars nationwide - and climbing. That’s unreimbursed extra time spent with patients, and their doctors, extra billing processes, and extra time parked on hold to pharmacy benefit help lines.
Northeast Pharmacy is a buying group representing 250 independent pharmacies in Massachusetts and Connecticut. Benoit says the difficulties of implementing Medicare Part D affect the chain pharmacies as well as the independents. That’s because the hundreds of Medicare Part D plans throughout the country have not, to date, been paying as promptly as Medicare and Medicaid did, creating an unexpected cash crunch for pharmacies.
He says that PDPs aren’t being held accountable by the government for the efficiency of their operations. But worse, he notes, are the extra steps pharmacists must take which slow operations down. An example: pharmacists are used to being able to process several different refills for one patient as a single transaction. Medicare Part D requires a separate transaction for each prescription.
And whether or not pharmacists get more volume from Medicare Part D remains to be seen. "They were coming to us anyway," he says. Pharmacies taking the biggest dent are those which used to have a lot of cash customers. Those people paid 100 percent of their drug cost up front. Now that they’re in Medicare Part D, the receivables they generate have jumped from zero to 30 days, Benoit says. "But I have to pay my wholesaler in less time than that," he says.
Looking forward, Benoit concurs with Ambrefe about expecting additional work for pharmacists as plans tighten up their formularies to favor lower-cost generic drugs. He says it’s pharmacists who will have to work things out between doctors and patients. And last but not least, the federal government is proposing to cut reimbursement to pharmacies for generic drugs in fiscal 2007. "The system’s got a long way to go," he says, "to work the way commercial plans worked a while ago."
Christina P. O’Neill can be reached at coneill@wbjournal.com
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