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Welch, Griffith Reintroduce Bipartisan Bill to Improve Medicare Part D Drug Pricing Transparency

January 24, 2019
Press Release
Bipartisan bill protects community pharmacies and Medicare Part D beneficiaries

WASHINGTON, D.C. – Reps. Peter Welch (D-Vt.) and Morgan Griffith (R-Va.) today reintroduced the Improving Transparency and Accuracy in Medicare Part D Drug Spending Act. The legislation would ensure that community pharmacists receive reimbursement at the rate posted at the time prescriptions are filled by prohibiting Medicare Part D plan sponsors and pharmacy benefit managers (PBMs) from retroactively reducing payments on accurate reimbursement claims submitted by pharmacies. Doing so would help ensure community pharmacies are able to continue to serve Medicare beneficiaries and combat the growing financial uncertainties these small businesses are facing.

“Rural pharmacies are essential to the delivery of health care in small communities across America,” said Welch. “Vermont’s community pharmacies provide quality service and lifesaving medication to Vermonters every day. Their long-term viability is essential. Retroactive fees are inappropriate and make it significantly harder for these small businesses to keep their doors open. Our legislation would put a stop to this practice.”

“Many residents of the Ninth District depend on their community pharmacists to fill their prescriptions,” said Griffith. “These pharmacists deserve to be reimbursed based on the price of drugs when they are dispensed, not when the prices are changed after the fact. This bill would end retroactive payment reductions, letting pharmacists focus on the most important priority of serving their customers.”

In 2008, Congress required that pharmacies be paid promptly, within 14 days, for accurate Medicare Part D reimbursement claims. They did so to ensure pharmacies could meet their financial obligations and continue to serve Medicare beneficiaries. Recently, Medicare Part D sponsors and PBMs have begun imposing a variety of retroactive fees on pharmacists which are collected weeks or even months after a prescription was filled. Centers for Medicare and Medicaid Services (CMS) is also currently considering a proposed rule that would reform the use of these fees

The Improving Transparency and Accuracy in Medicare Part D Drug Spending Act would prohibit the imposition of such fees for accurate claims. This would allow pharmacists to continue to serve Medicare beneficiaries and others in their communities who rely on them and provide needed financial certainty for these often small businesses. In addition, it would provide greater transparency in drug pricing for the Part D beneficiaries who will have more accurate information available online.