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ALEXANDRIA, Va. — The National Community Pharmacists Association on Friday announced “grave concerns” regarding a purported Oregon Medicaid plan amendment that would, according to the association, renege on a pact the state previously reached with the Centers for Medicare and Medicaid Services and cut Medicaid pharmacy reimbursement for the second time this year.
Earlier this year, CMS approved a state plan amendment proposal by Oregon that reduced pharmacy reimbursement by basing it on the pharmacy’s average acquisition cost instead of the average wholesale price. This cut was mitigated by an accompanying increase in its dispensing fee to better reflect pharmacy costs. In discussions with the pharmacy community, CMS has indicated that a shift to an AAC-based reimbursement methodology needs to be considered simultaneously with an enhanced dispensing fee.
In a letter to CMS this week, NCPA stated it was “cautiously optimistic that a switch to AAC could be an appropriate method on which to base pharmacist reimbursement as long as such a proposal would be considered simultaneously with an enhanced dispensing fee.”
However, Oregon’s latest SPA would reduce the new dispensing fee and set a “dangerous precedent,” the NCPA said. “In effect, states could win CMS approval for a shift to the lower, AAC-reimbursement benchmark by also agreeing to increase pharmacy dispensing fees. Then the state could later pare back the dispensing fee, further reducing pharmacy overall reimbursement and potentially jeopardizing Medicaid patients’ access to pharmacies, some of which may be forced to leave the Medicaid program rather than dispense at a financial loss.”
“Independent community pharmacists are the backbone of the Medicaid drug benefit and often serve rural and urban areas that have few, if any, other pharmacy providers,” NCPA EVP and CEO Douglas Hoey said. “Local pharmacists can help states reduce their Medicaid costs by promoting low-cost generic drugs, where appropriate, and through face-to-face counseling on the proper use of medication. Unfortunately, this proposal is a step in the wrong direction and turns a blind eye toward the health needs of Medicaid patients. For these and other reasons, CMS should not approve it.”
Currently, there are 160 independent community pharmacies in Oregon, NCPA reported.