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Pharmacists Prepare to Flee California Medicaid Program

In 2009, and again in 2011, DHCS submitted requests to CMS to cut reimbursements for pharmacists, physicians, hospitals and dentists. For pharmacists, these cuts would results in a 15 percent reduction in Medi-Cal prescription payments, which are already at breakeven for most pharmacies. Both requests are currently pending with CMS.

“A recent CPhA survey makes it clear that pharmacies are at their breaking point and will have no choice but to leave the Medi-Cal program,” said Jon Roth, Chief Executive Officer of CPhA. “When presented with the facts that Medi-Cal would no longer cover the cost of the drug and pharmacist’s services, seven-in-ten (72%) would decline to fill Medi-Cal prescriptions, which is contrary to their longstanding record of service to these patients,” continued Roth.

The survey, which asked pharmacies what they will do should the cuts be approved, paints a dire picture. The results support data presented to DHCS in 2009 indicating that even the 5 percent reduction being considered at that time would result in 99 percent of the most utilized drugs in the Medi-Cal program being reimbursed below the pharmacist’s actual cost. When confronted with the possibility of an additional 10 percent cut, pharmacists clearly indicated they would be forced to flee the program. In this scenario, 90 percent of pharmacies reported that they would decline new Medi-Cal prescriptions and 43 percent would likely close their pharmacy.

Source: Business Wire (press release)

Benefit Managers Can Fight Calif. Law ... - Courthouse News Service

     (CN) - The 9th Circuit will take another look at California laws that require pharmacy benefit managers to report drug-pricing information to insurance companies and other clients.
     A three-judge panel of the federal appeals court in San Francisco found the state statutes constitutional in July, but a majority of judges agreed Monday to convene a full, 11-judge panel to rehear the case.
     A group of retail pharmacies sued several pharmacy benefit managers (PBMs) in 2002 to enforce laws that require managers to conduct biannual studies of local pharmacies' retail drug pricing for private, uninsured customers, and to release those studies to their clients. The managers argued that the laws were unconstitutional because they unlawfully compelled speech....

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ASOP Supports U.S. House of ... - Alliance for Safe Online Pharmacies

by Alliance Editor

Washington (October 31, 2011) – Today, the Alliance for Safe Online Pharmacies (ASOP) is pleased to support the introduction of legislation that will assist in addressing the illicit activities of illegal online drug sellers. The Stop Online Piracy Act (H.R. 3261) was introduced on October 26, 2011, by Rep. Lamar Smith (R-TX) and a bi-partisan group of 12 other members of Congress. Similar legislation was previously introduced in the Senate in May by Senators Patrick Leahy (D-VT), Orrin Hatch (R-UT) and Charles Grassley (R-IA).

Despite the existence of many safe online pharmacies, estimates show that the overwhelming majority (92-95%) of entities offering to sell drugs online are illegitimate and operate in clear violation of U.S. laws that were put in place to protect patients. Internet commerce companies have the ability to take voluntary actions to stop doing business with illegal online drug sellers, and now the Stop Online Piracy Act gives them every incentive to do so. If adopted, the Act will send a clear message that companies should stop facilitating criminal online activity that endangers public health and safety.

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California pharmacy Law Book 2011 News

Pharmacists Prepare to Flee California Medicaid Program

Business Wire (press release) - Dec 31, 1969

Services (CMS) outlining why proposed cuts by the California Department of Health Services (DHCS) Medicaid program (entitled Medi-Cal) violate federal law and will result in pharmacists being forced out of the program. In 2009, and again in 2011,

Calif. Hospital Association lawsuit challenges cuts to 2011 Medicaid rates

ModernHealthcare.com - Dec 31, 1969

With the Supreme Court already digesting arguments on whether cuts to Medicaid rates in 2008 jeopardized California's federally guaranteed access to care, state officials received permission to cut 2011 rates further—and were swiftly met

ScripNet Launches – ScripNet Insurance Payment Solutions™ (SNIP) to Address ...

The Open Press (press release) - Dec 31, 1969

Seeing the reduction in errors, handling costs and time to process bills gained by group health, state legislatures, starting with Texas and Minnesota in 2009 and California in 2011, have passed laws requiring eBilling for workers' compensation.

Pfizer, Occupy Wall Street, Oliver Smith: Intellectual Property

Bloomberg - Dec 31, 1969

Along with trying to get an over-the-counter Lipitor to market, the company has struck agreements with pharmacy benefit management companies including Medco Health Solutions Inc. and Express Scripts Inc. to sell brand-name Lipitor at a lower price,