Pharmacists oppose Medicaid reimbursement rate

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(Host) Vermont’s pharmacists say a proposed reimbursement rate for Medicaid prescriptions will drive some of them out of business.

They say they’re frustrated that the state is taking what they call a wait and see approach to a crisis that could affect the access Vermonters have to medicine.

The state says it’s aware of the situation and will act if necessary to help pharmacists.

VPR’s Steve Zind reports:

(Zind) More than half of the prescriptions filled by Vermont pharmacists are for people in the Medicaid program.

How much pharmacies will be reimbursed for these generic medicines is determined by the government.

Pharmacists say a new proposed federal formula means they’ll be reimbursed for only 65% of the actual cost of Medicaid prescriptions.

The change is scheduled to take effect July 1st.

Pharmacists say the new formula will only add to the losses they’re already incurring under the Medicaid and Medicare programs, driving some of them out of business and cause others to refuse to take Medicaid prescriptions. Phil O’Neill is a Bennington pharmacist.

(O’Neill) “This is about the pharmacy you go to in each of your communities. Whether or not they will be able to go ahead and stay viable. I can speak to southern Vermont and tell you that in the southern part of our state in the last year, before this has even happened, since Medicare Part D came into place, four pharmacies have closed.”

(Zind) O’Neill was one of a group of pharmacists who came to the State House to lobby lawmakers in the waning days of the session. They say they’re frustrated that the state hasn’t acted to address the proposed lower federal reimbursement.

Joshua Slen directs the Office of Vermont Health Access which manages the Medicaid program. Slen says he’s concerned about the proposed changes, but they’re not yet finalized and at this point it’s too early to tell what effect they’ll have.

(Slen) “As soon as we have evidence as to how those regulations will impact, in fact, not acting out of fear that the sky is falling, then we will act on those.”

(Zind) Slen says the state plans to assess the impact of any changes in the Medicaid prescription reimbursement by collecting information during the first half of next year.

Pharmacists say that will be too late for some of Vermont’s 145 pharmacies, and for their customers.

They say the real answer to the problem is Congressional action to force pharmaceutical companies to reduce drug costs.

For VPR news, I’m Steve Zind in Montpelier.

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