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Health Care Reform:

Health Insurance & Affordable Care Act

New System Intended to Shorten Medicare Prescription Fill Time

WebMD Health News

Part D Pharmacy Wait Times Targeted

April 19, 2006 -- A new system for communicating to insurance companies will help seniors get faster service under Medicare's Part D prescription drug benefit, insurance and pharmacy groups said Wednesday.

The groups announced that they had agreed on a way to standardize computer messages between drug plans and pharmacies to simplify prescription filling at the pharmacy counter. The plan is meant to reduce some confusion resulting from the dozens of private plans confronting seniors and pharmacies under Part D.

Seniors in most states are choosing between 40 -- and sometimes up to 60 -- private Medicare drug plans. That has led to complaints of confusion from beneficiaries but also to angry reactions from pharmacists who face dozens of different standards for communicating with plans over coverage issues.

"The frustration that it causes ... I just can't tell you how frustrating it is," Bruce Roberts, president of the National Community Pharmacists Association, told reporters.

Under the agreement, insurers and pharmacies agreed to a single format for sending computerized messages back and forth when pharmacists need to check whether a drug is covered. Until now, those communications have left pharmacists waiting on the phone, sometimes for hours, while customers wait.

"It causes chaos in the pharmacy," Roberts said. "This will make a tremendous difference."

Karen Ignani, president of America's Health Insurance Plans, an industry trade group, said the new standard "makes life better for our customers."

Roberts said the move will get pharmacists "off the phone" when coverage issues arise. But officials could not say how much faster the prescription filling process would be with the new communications methods.

Medicare chief Mark McClellan, MD, said that participation by insurers technically remained voluntary, but that the program expected plans to participate fully by next month.

The first months of Part D's implementation were plagued by glitches, including one that prevented hundreds of thousands of low-income beneficiaries from receiving their prescriptions. Much of the problem was caused when patient records did not show up in insurance company databases and pharmacists could not confirm available benefits.

McClellan maintained that the new communications standards would not have helped stop that problem.

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