Audits overwhelm pharmacists

Tuesday, September 18, 2012

ALEXANDRIA, Va. – Audits are hammering community pharmacists and that puts patient access at risk, according to a new survey.

The National Community Pharmacists Association (NCPA) asked more than 350 community pharmacists about their experiences with audits conducted by pharmacy benefit managers (PBMs) and other Medicare Part D intermediaries.

The survey found that:

• Ninety-six percent of pharmacists stated that a typical PBM contract has minimal or no transparency on how generic pricing is determined or what the reimbursement rate will be.

• Almost 50% of respondents said that more than 10% of the time, PBMs set maximum allowable costs (MAC) reimbursement for generics below the pharmacy’s cost just to acquire the drug, much less dispensing and overhead costs. 

• About 76% say audit requirements across Medicare Part D plans are inconsistent.

• Nearly 87% stated that PBM reimbursement and auditing practices “significantly” or “very significantly” affect their ability to provide patient care and remain in business.

"Patients over paperwork; and fair reimbursement practices—that’s all these pharmacists are asking for,” said NCPA CEO B. Douglas Hoey in a press release. “An estimated $290 billion in costs each year are attributed to the improper use of medication."

The NCPA has endorsed H.R. 4215, the Medicare Pharmacy Transparency and Fair Audit Act. The bill, introduced earlier this year by Rep. Cathy McMorris Rodgers, R-Wash., would address "abusive" auditing practices.