WASHINGTON, D.C. –
Former pharmacist and Congressman Marion Berry (AR-01), along with a more than two-thirds of the House and Senate Members voted to override President Bush's veto of H.R. 6331, the Medicare Improvements for Patients and Providers Act of 2008, enacting the bill into law last night. The Medicare bill included Rep. Berry's bill H.R. 1474, the Fair and Speedy Treatment (FAST) of Medicare Prescription Drug Claims Act of 2007, which has a total of 253 cosponsors. The legislation will help keep community pharmacies from going out of business by mandating that insurance companies provide prompt reimbursement under the Medicare Part D prescription drug benefit.
"Community pharmacists are often the first and only medical professionals patients go to for medical advice because they are unable to afford a doctor's visit, travel to an office or purchase health insurance,” said Berry. "This bill is a simple reform that will make sure pharmacists are not financially held hostage by insurance companies and able to continue to provide their essential services to patients."
Since the implementation of Medicare Part D, more than 1,152 community pharmacies have been forced to close their doors. The University of Texas at Austin’s Center for Pharmacoeconomic Studies’ August 2007 report found the median percentage of pharmacy claims that took 30 days for reimbursement was 50.1 % and 17.2 % of claims took over 60 days. While pharmacists often wait over a month for reimbursement, they must pay their wholesaler every 15 days often putting them in extreme financial hardship.
Key Provisions of the Legislation:
- H.R. 1474 - Mandates that clean claims submitted electronically to insurance companies be paid within 14 days, and all other clean claims must be paid within 30 days. Pharmacists must also be promptly notified if there are problems with submitted claims.
- Delays implementation of a change to the Medicaid drug pricing formula which would have changed Medicaid’s payment limits to be based on the Average Manufacturers Price. This will ensure that pharmacies continue to be reimbursed fairly while a new reimbursement formula is developed. If the rule is implemented as it currently stands today, a pharmacy will be forced to accept payments for Medicaid prescriptions 36 percent below cost or be forced to stop participating in Medicaid.
- Postpones the Durable Medical Equipment (DME) competitive bidding program and repeals the clinical laboratory competitive bidding program. This will permit pharmacies to continue selling DME rather than be shut out to winning bidders.
- Prevents the 10.6% reduction in Medicare reimbursement rates to physicians
- Will ensure active-duty military personnel and military retirees can access to the doctors they know and trust in Tricare. When Medicare cuts physicians payments, Tricare physician payments are cut as well – threatening the access of Tricare participants have to their doctors.
- Enhances Medicare preventive and mental health benefits and increases the amount of assets that low-income beneficiaries can have and still qualify for help with Medicare costs
- Improves Medicare for both health care providers and beneficiaries in rural America, including improving payments for sole community hospitals, critical access hospitals, and ambulances.
- Includes new prohibitions and limitations on marketing activities permitted by Medicare Advantage Plans, which Congressman Berry has taken a stand against after dozens of scams targeting seniors were reported throughout the First District.
"As health care costs continue to skyrocket, hardworking taxpayers are forced to choose between the medication they need and putting food on the table or gas in their car," said Berry. "The passage of this bill is a key victory in reforming our broken health care system. With this new law, Congress worked together to enact a law that stands up to insurance companies to provide better health care for our seniors, our health care providers, our military families, and our disabled."
