Pharmacy groups hail bipartisan effort to lift Medicaid generic dispensing rates

ALEXANDRIA, Va. A new push from members of both parties in the House of Representatives to boost Medicaid prescription payments drew strong praise Thursday from the chain and independent pharmacy lobby, and also drew calls from industry leaders to make fair Medicaid reimbursement system part of health-reform legislation.

To that end, a bipartisan group of 16 members of Congress sent a letter urging House Speaker Nancy Pelosi, D-Calif., to consider a higher federal upper limit by which Medicaid could reimburse community pharmacies for dispensing generic drugs. Leaders of both the National Association of Chain Drug Stores and the National Community Pharmacists Association welcomed the move.

In their appeal to the speaker, the House members raised concerns about the Medicaid prescription payment levels now envisioned in the health reform bills proposed in the House and Senate. While both bills include proposals to modify the severe payment cuts pushed through two years ago – cuts that remain on hold thanks to a court injunction – the 16 lawmakers urged Pelosi to take a fresh look at the issue.

"We are still concerned that the reimbursement levels proposed will not be sufficient to assure that Medicaid patients will be able to obtain prescription medications through their community pharmacies," the representatives told Pelosi. "This could reduce Medicaid patients’ access to many pharmacies and negatively impact generic dispensing."

As currently written, the health-reform proposal passed last month by the House of Representatives contains a proposal for Medicaid to pay pharmacies at 130% of the weighted average of the drug’s acquisition cost as defined by its average manufacturer price, or AMP. The appeal to the House leader comes as furious debate continues in the Senate over a health reform package championed by Senate Majority Leader Harry Reid, D-Nevada, and other Democrats. The Senate bill calls for generics dispensed under Medicaid to be reimbursed at 175% of the weighted average.

If and when that bill is passed, it must then be reconciled with the House health reform bill through House-Senate negotiations. But as currently written, neither Medicaid reimbursement formula may be enough, lawmakers warned Pelosi.

"We respectfully urge you to consider a higher federal upper limit reimbursement rate for generics for pharmacies," they noted in their letter. "Community pharmacies play a critical role as primary health care providers in all communities across the United States and often serve as the only resource to millions of lower income Americans for their daily needs. Failure to adequately fix the Medicaid pharmacy reimbursement would directly impact these patients and the pharmacies that continue to serve them."

NACDS and NCPA strongly endorsed the appeal. "As the face of neighborhood health care, pharmacy is the most convenient and accessible healthcare provider," said NACDS president and CEO Steve Anderson. "We are pleased that these members of Congress are working on behalf of pharmacy to ensure that Medicaid patients have access to their prescription drugs and other pharmacy services. These patients should not be penalized due to an unfair reimbursement model."

Added NCPA EVP and CEO Bruce Roberts, "NCPA sincerely appreciates this bipartisan show of support for community pharmacy. Clearly, lawmakers across the political spectrum recognize the important role community pharmacists play in helping Medicaid recipients – and want to continue to play. But for that to happen, Congress must replace these deep cuts with an equitable reimbursement system."

The letter was signed by Reps. Michael Arcuri (D-N.Y.), Joe Barton (R-Tex.), Marion Berry (D-Ark.), Sanford Bishop (D-Ga.), Leonard Boswell (D-Iowa), Rick Boucher (D-Va.), Christopher Carney (D-Pa.), Joe Courtney (D-Conn.), Lloyd Doggett (D-Tex.), Walter Jones (R-N.C.), Jerry Moran (R-Kan.), Cathy McMorris Rodgers (R-Wash.), Stephanie Herseth Sandlin (D-S.D.), Timothy Walz (D-Minn.), Anthony Weiner (D-N.Y.), and Peter Welch (D-Vt.).