Capito’s Legislation Deals with Medicare Part D

Sens. Shelley Moore Capito (R-W.Va.) and Jon Tester (D-Mont.) introduced legislation Tuesday that would prohibit Medicare Part D plan sponsors and pharmacy benefit managers (PBMs) from retroactively reducing payments on accurate reimbursement claims submitted by pharmacies.

The “Improving Transparency and Accuracy in Medicare Part D Drug Spending Act” aims to help ensure community pharmacies are able to continue to serve Medicare beneficiaries. The bill also aims to combat the growing financial uncertainties these small businesses are facing.

“Community pharmacies that serve rural communities face similar challenges to other small businesses with limited access to capital,” Capito said. “The uncertainty in Medicare Part D drug pricing has also become a major concern for community pharmacies.”

She said by stabilizing the amount of money these pharmacies pay for prescriptions, more patients will have access to the medications they need. 

“I hear it more and more during my travels across Montana, the market for prescription drugs is broken and we need to act to hold drug companies and middlemen accountable,” Tester said. “This bipartisan legislation will do just that and ensure excessive profits aren’t being extracted at the expense of the community and rural pharmacies that serve America’s seniors.”

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. 

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 beneficiaris and others in their communities who rely on them and provide needed financial certainty for these often small businesses. 

Additionally, the bill would provide greater transparency in drug pricing for the Part D beneficiaries who will have more accurate information available online.

The bill is co-sponsored by Senators John Boozman (R-Ark.) and Tom Cotton (R-Ark.). Identical legislation was introduced in the House by Reps. Morgan Griffith (R-Va.), Peter Welch (D-Vt.), Earl “Buddy” Carter (R-Ga.), Walter Jones (R-N.C.), Cathy McMorris Rodgers (R-Wash.) and Pete Sessions (R-Texas).