WASHINGTON, D.C. – U.S. Senators Shelley Moore Capito (R-W.Va.) and Jon Tester (D-Mont.) reintroduced the Improving Transparency and Accuracy in Medicare Part D Drug Spending Act. This legislation, which was previously introduced in the 115th Congress, would prohibit 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. 

“It is essential patients have access to the medications and information they need from those they trust,” said Senator Capito. “Community pharmacies are important to our small towns and rural areas and must remain open and accessible to Medicare patients.” 

“Rural health care providers are the backbone of towns and cities across Montana, and America,” Senator Tester said. “But just like any small business, these hospitals, clinics, and pharmacies need stability and certainty to survive. That’s why we’re introducing this bipartisan bill once again, to ensure neighborhood pharmacies aren’t subjected to the financial whims of medical bureaucrats and middlemen.” 

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 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.  Identical legislation was introduced in the House of Representatives (H.R. 803) by Representatives Peter Welch (D-Vt.) and Morgan Griffith (R-Va.). 

In February, Senators Capito and Tester lead a letter to the Department of Health and Human Services Secretary Alex Azar in support of the inclusion of direct and indirect remuneration (DIR) fee reform in the Centers for Medicare & Medicaid Services’ proposed rule on the Medicare Part D for plan year 2020 and urged the finalization of the proposal.  Joining them on the bipartisan letter were Senators Inhofe, Collins, Cantwell, Carper, Murkowski, Thune, Brown, Wicker, Boozman, Hoeven, Manchin, Moran, King, Cassidy, Cotton, Daines, Ernst, Gardner, Lankford, Perdue, Rounds, Sullivan, Kennedy, Jones, Hyde-Smith, Blackburn and Cramer.


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