Capito, Tester Reintroduce Bipartisan Bill to Improve Medicare Part D Drug Pricing Transparency

Bipartisan bill protects community pharmacies and Medicare Part D beneficiaries

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 114th 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.

“Community pharmacies are important to our small towns and rural areas, and must remain open and accessible to Medicare patients. The uncertainty in Medicare Part D drug pricing has posed many challenges for these small operations, but our bill will help stabilize the prices community pharmacies pay for prescriptions and allow more patients to access the medications they need,” said Senator Capito.

“Seniors are being forced to pay more for prescription drugs than ever before, this is a major problem and we have to hold everyone accountable,” Senator Tester said.  “No one should raise prices and grow profits at the expense of seniors and the medical providers and pharmacies that serve rural families.”

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.

The bill is co-sponsored by Senators John Boozman (R-Ark.) and Tom Cotton (R-Ark.), James Lankford (R-Okla.), Chuck Grassley (R-Iowa), Heidi Heitkamp (D-N.D.) and Roger Wicker (R-Miss.). Identical legislation was introduced in the House (H.R. 1038) by Reps. Morgan Griffith (R-Va.) and Peter Welch (D-Vt.)