June 15, 2010

(Washington, DC) — Pharmaceutical Care Management Association (PCMA) President and CEO Mark Merritt released the following statement on today’s U.S. House Ways and Means Committee Health Subcommittee and Oversight Subcommittee joint hearing on reducing fraud, waste, and abuse in Medicare:

“A good way for policymakers to renew the fight against fraud, waste, and abuse would be to reject policies that inadvertently facilitate such activities. Policymakers should encourage, not discourage, the use of proven fraud prevention tools.

“We should not rely solely upon after-the-fact ‘pay and chase’ methods, which generate only mixed results. It’s more difficult, expensive, and time-consuming to confront fraud once it has already occurred. That’s why pharmacy benefit managers use a variety of state-of-the-art techniques to detect and prevent fraud, waste, and abuse before it happens. Policymakers should reconsider the following policies that could undermine these efforts and inadvertently facilitate fraud, waste, and abuse:

  • Proposed requirements that payers include in their networks pharmacies that have been banned from federal programs.
  • Proposed requirements that pharmacies that commit fraud are granted a long waiting period before they can be removed from networks.
  • Proposals that would grant independent pharmacies special rights to get ‘advance’ notice of audits.
  • Requirements to accelerate Part D payment schedules, which give less time for public and private payers to monitor, detect, and root out fraud, waste, and abuse.
  • Exemptions that would allow independent pharmacies to avoid routine accreditation requirements to sell Durable Medical Equipment (DME).

“Policies such as these undermine the essential system of checks and balances critical to effective oversight and accountability.”