Libby introduces bill to protect local independent pharmacies

AUGUSTA — Sen. Nate Libby, D-Lewiston, on Thursday introduced a bill that would protect Maine’s local independent pharmacies and improve cost transparency for prescription drugs. LD 1928, “An Act To Prohibit Health Insurance Carriers from Retroactively Reducing Payment on Clean Claims Submitted by Pharmacies,” received a public hearing before the Legislature’s Health Coverage, Insurance and Financial Services Committee. 

“Simply put, this bill protects Maine’s local pharmacies from unforeseen costs on something that had already been paid for,” said Sen. Libby. “Unfortunately it seems that these small business owners are often jerked around by massive insurance companies just the same as their customers are.”

LD 1928 would prohibit a health insurance carrier from retroactively reducing payment on a properly submitted claim by a pharmacy. The bill also would prohibit an insurance carrier from charging a pharmacy or holding the pharmacy responsible for any fee related to a claim that is not apparent at the time the insurance carrier processed the claim, that is not reported on the remittance advice or after the initial claim is adjudicated by the carrier.

Several small business pharmacy owners submitted testimony in favor of the bill. 

“I have incurred fees to the tune of $120,000 per year retroactively,” said Michele LeBlanc, owner of Taylor’s Drug Store in Madison. “Imagine trying to run a business, let alone establish a budget, with the information received at point of adjudication being incorrect.”

The bill faces further action in committee and votes in the Maine Senate and House.