Time from Medicare Part D claim adjudication to community pharmacy payment

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.