PCMA: ‘Phantom Pharmacies’ Highlight the Need for Vigilant Anti-Fraud Measures

Independent Pharmacy Lobby’s Agenda Could Undermine Fraud Detection Efforts

WASHINGTON--(BUSINESS WIRE)-- The Medicare fraud caused by independent “phantom pharmacies” highlights the need to resist the independent pharmacy lobby’s efforts to dismantle programs that fight fraud, waste, and abuse, the Pharmaceutical Care Management Association (PCMA) said in letters sent to Senate Finance Committee Ranking Member Charles Grassley (R-Iowa) and Health and Human Services (HHS) Secretary Kathleen Sebelius.

PCMA is the national association representing America’s pharmacy benefit managers (PBMs), which administer prescription drug plans for more than 210 million Americans with health coverage provided through Fortune 500 employers, health insurers, labor unions, and Medicare. PBMs and Medicare Part D plans employ a variety of state-of-the-art techniques when working with pharmacies and other stakeholders to combat fraud, waste, and abuse. The federal government states that a staggering $60 billion is stolen from taxpayers through Medicare scams every year.

“Given the size of the deficit, we can’t afford to let anyone, including the independent pharmacy lobby, thwart congressional efforts to fight pharmacy fraud,” said PCMA President and CEO Mark Merritt.

In the letters to Senator Grassley and Secretary Sebelius, PCMA outlines several proposals being pushed by the independent pharmacy lobby that could make it more difficult to root out fraud, waste, and abuse:

  • Mandating PBMs contract with pharmacies that are currently banned from participating in federal programs.
  • Opposing the Office of Inspector General’s ability to prosecute pharmacists charged with a felony.
  • Undermining the President’s proposal to enhance Medicaid fraud enforcement.
  • Requiring a lengthy waiting period of time to remove a pharmacy from a network even with irrefutable evidence of fraud.
  • Creating unnecessary hurdles that hinder the ability of plans to audit pharmacies thoroughly.
  • Exempting independent pharmacies from routine accreditation requirements to sell Durable Medical Equipment (DME).

PCMA represents the nation’s pharmacy benefit managers (PBMs), which improve affordability and quality of care through the use of electronic prescribing (e-prescribing), generic alternatives, mail-service pharmacies, and other innovative tools for 210-plus million Americans.

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Charles Coté, 202-207-3605

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