Survey shows it takes one month or longer for PBMs to fix maximum allowed costs underpayments
THURSDAY, April 9, 2015 (HealthDay News) — Nearly all pharmacists have experienced upswings in the acquisition costs of generic drugs, with price spikes reported to be worse since 2013, according to a report published by the National Community Pharmacists Association (NCPA).
In a survey of 700 community pharmacists, almost all pharmacists reported experiencing a large upswing in the acquisition cost of a generic drug over the past six months. Most pharmacists (93.4 percent) reported that the situation had gotten worse since 2013.
Most pharmacists report that it takes third-party payers one month or more to update pharmacy reimbursement rates accordingly (one to two months, 24.7 percent; three months or more, 62.3 percent). Most (92.8 percent) pharmacists report that the situation has gotten worse with respect to absorbing financial losses on these prescriptions. The typical response on appeal to pharmacy benefit management is rejection of appeal (56.9 percent), with no response in 25.9 percent of cases.
“This survey finds that this problem has only grown more severe over the past two years and requires urgent attention from federal and state policymakers,” B. Douglas Hoey, R.Ph., M.B.A., chief executive officer of the NCPA, said in a statement. “Some patients are already skipping medication due to higher prices and copays or are forced into the Medicare coverage gap or ‘donut hole’ sooner.”
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