PACE

 Provider Bulletin

March 27, 2009

Pennsylvania Rx Price Finder Website

 

Last July, it was announced that the Commonwealth was creating a website that would permit the public to access pharmacy usual and customary pricing information.

 

Although this website has been accessible since last fall, it was officially launched on March 10, 2009.  Website prices are updated weekly and are based on the usual and customary prices that PACE providers submit on their claims. The Usual and Customary price is defined by PACE Regulations as:

An enrolled provider's charge to the cash-paying public for a prescription drug, in a specific strength and quantity within a specific calendar month.  Discounts or coupons offered to the cash-paying public shall be considered to be offered to the Commonwealth as well.  Discounts applicable to cardholders or coupons presented by cardholders shall be accepted by the provider and credited to the PACE/PACENET Program payment and not the co-payment.”

 

Early comments received from website users indicated that, in some cases, pharmacy prices submitted to the Program and posted on the website were not the same as the prices stated when potential consumers contacted the pharmacy.

 

In response to these consumer comments, these discrepancies were confirmed by the Program’s own sampling.

 

Two glaring differences were revealed:

·   In some cases, prices quoted over the phone for a drug surveyed within the past 30 days ranged from 50% to 88% LESS than the price charged to the Program.

·   In other instances the U&C price submitted to the Program for a drug dispensed within the past 30 days was the primary payer’s contracted price. This incorrect information resulted in U&C prices as much as 80% lower than the price quoted by phone. 

 

This incorrect pricing information is both misleading and violates the provider Agreement.

·         In instances when the price given to the cash paying public is below the price charged to the Program and posted on the website, the provider can lose potential customers. Additionally, once the correct cash price (Usual and Customary) is identified, the Program can adjust previous Program payments.

·         In cases when the Price submitted to the Program as their Usual and Customary is far below the cash price, it is expected that this lower price will be honored when a customer cites the Commonwealth’s web price for a drug with a surveyed  date within the past 30 days. The Provider, by contract, is to submit the usual and customary price to the Program.

 

Although PACE cardholders have fixed co-pays, this website can be a valuable tool for pharmacies and non-PACE cardholders. Providers are encouraged to use this free promotional source to attract potential customers by insuring their prices are accurate and that their pharmacy store hours and days of operation and other information on the website is up-to-date at www.parxpricefinder.com.

 

Provider updated information, comments and questions about this website should be directed to Provider Services at 1-800-835-4080.