Abstract. Objective: To determine the average payment time from Medicare Part D plans to
community pharmacies for prescription drugs dispensed to Medicare beneficiaries.
Design: Nonexperimental time series.
Setting: United States in January to December 2006.
Participants: 145 independent pharmacies and 17 regional chain pharmacy firms.
Intervention: Review of 2,944,526 Medicare Part D prescription drug claims
adjudicated in 2006.
Main outcome measures: Median payment time and the number and proportion
of claims paid, controlling for month of claim adjudication, pharmacy type, and Part
D plan.
Results: The median payment time for 2006 claims filed by all pharmacies in this
study was 29.0 days (mean 39.1). The median payment time was greater for independent
pharmacies (median 31.0, mean 49.1) than chain pharmacies (median 29.0, mean
36.5). Payment was slower during the first few months of the Medicare Part D benefit
than later in the year. By December, approximately 40% of the claims were not paid
within 30 days. Within the 12 plans identified as having the greatest number of claims
in the sample, the median payment time ranged from 23.0 days to 36.0 days.
Conclusion: Payment times improved during 2006, but a sizable proportion of
claims were not paid within 30 days. Chain pharmacies received payments sooner than
independent pharmacies. Additionally, a wide variation in median payment times was
observed for Part D plans. The results of this study, based on actual claims data, are
not in agreement with findings from a survey of Part D plans reported by the Centers
for Medicare & Medicaid Services.
Keywords: Medicare Part D, prescription drug plans, payment systems.