(Washington, DC)—Legislation (The Medicare Prescription Drug Program Integrity and Transparency Act, S. 867) championed by the independent drugstore lobby would undermine the ability of Medicare Part D plans and pharmacy benefit managers (PBMs) to detect pharmacy fraud, waste, and abuse in Medicare, the Pharmaceutical Care Management Association (PCMA) said today. S. 867 would limit the use of audits and other tools that uncover fraud in the pharmacy setting.
“Policymakers want to reduce health costs for the government, but the drugstore lobby wants new laws that would increase wasteful spending on prescription drugs and make fraud, waste, and abuse harder to detect,” said PCMA President and CEO Mark Merritt.
PCMA recently launched a new ad campaign that highlights how the independent drugstore lobby’s agenda results in more wasteful spending and higher prescription drug costs.
Fraud, waste, and abuse costs Americans up to $234 billion a year, according to the National Health Care Anti-Fraud Association (NHCAA). At independent drugstores, the owner, cashier, and book keeper are often one and the same. These factors make independent drugstores more susceptible to irregularities and make oversight more challenging.
A report released last year by the Office of the Inspector General (OIG) of the Department of Health and Human Services found that Medicare paid $5.6 billion to pharmacies with “questionable billing” practices. The OIG report also found that independent pharmacies were eight times more likely than other pharmacies to have questionable billing practices.
A white paper published by NHCAA also raised serious questions about the kind of legislative proposals promoted by the independent drugstore lobby. Specifically, NHCAA supports measures that would “protect the integrity of health care audits by giving auditors more discretion and flexibility to perform their duties” and notes that “on-site audits have revealed indications of fraud such as nonexistent pharmacies, unexplained stockpiles of controlled substances, mismatches between inventories and prescriptions and other discrepancies.”
New data from the Bureau of Labor Statistics (BLS) also shows that independent drugstores are part of a successful and growing industry. This information undermines the independent drugstore lobby’s agenda for government mandates to protect them from competition.
According to BLS (as reported in Drug Channels):
- In 2012, average gross salary for pharmacists at retail, mail, and specialty pharmacies was $117,000, up 2.6% from 2011.
- The average pharmacist salary grew faster than that of the average healthcare worker. In 2012, pharmacist salaries grew by 2.7% (range: 2.0% to 3.8%). By comparison, salaries for all health care works grew by only 1.1% in 2012.