ALEXANDRIA, Va., Aug. 3, 2011 /PRNewswire-USNewswire/ —
A new survey of 1,850 members of the National Community
Pharmacists Association (NCPA) released today has identified
two rising problems that are increasingly undermining the
trusted, cost-saving patient care that
millions of seniors and other Americans rely on from
independent community pharmacists.
NCPA asked community pharmacists about their experiences with
pharmacy audits and generic-drug reimbursement limits (known as
“maximum allowable costs” or MACs). Employers and health plans
often contract audit and MAC-setting responsibilities to
controversial, middlemen known as pharmacy
benefit managers (PBMs), which also operate mail order
facilities that compete with local pharmacies.
The survey produced two main findings. First, the pharmacy
audits, rather than concentrating on true fraud, often punish
pharmacies severely for trivial issues (e.g., a busy physician
misspelling a patient’s name or writing the incorrect date).
Second, pharmacies are not privy to basic reimbursement (MAC)
methodology prior to signing contracts with health plans and find
that, during the life of contract, those MAC limits are both
lowered arbitrarily and raised belatedly in