PACE
Provider
Bulletin
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
“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.