The National Community Pharmacists Association is urging Congress to preserve Medicaid patients’ access to approximately 23,000 community pharmacies.
“Community pharmacies and, more importantly, our Medicaid patients are vulnerable because our ability to serve them could soon be compromised,” said NCPA Executive Vice President and CEO Bruce T. Roberts. “Ensuring patient access to community pharmacies prevents far costlier visits to doctor’s offices or emergency rooms."
When the Medicare Improvements for Patients and Providers Acts of 2008 (MIPPA) became law in July 2008, it included a provision delaying implementation of Medicaid pharmacy reimbursement cuts, based on the Centers for Medicare and Medicaid Services' regulation from July 2007, using an average manufacturer price (AMP) formula. The moratorium expires Sept. 30.
Congress gave pharmacies and Medicaid patients that added protection in reaction to a December 2007 court-imposed temporary injunction in a lawsuit brought by NCPA and the National Association of Chain Drug Stores.
The current healthcare reform bill in the House (H.R. 3200) offers some relief, but could still force community pharmacies to dispense generic drugs at a loss. No legislation addressing the AMP payment cuts is on the docket.
“Any small business owner will tell you they can’t pay out more money than they bring in,” said Roberts. “That is the predicament community pharmacies are facing with Medicaid.”
In December 2006, he said, the Government Accountability Office looked at how pharmacies, on average, would be affected if these cuts were passed by Congress. The GAO found pharmacies would be reimbursed at least 36 percent below a drug’s cost.
“Independent community pharmacies serve rural and urban communities where they are often the sole healthcare provider,” said Roberts. “We believe a fair solution can be found with Congress. However, that won’t be possible without an extension of the moratorium.”