Friday, January 08, 2010

Wash State Pharmacy says no more Medicaid Prescriptions

Link

The announcement comes three months after a group of Washington pharmacies and trade associations filed suit in federal court claiming they're not reimbursed enough for Medicaid prescriptions. That lawsuit — the second filed here in the past 10 months on pharmacy reimbursement rates — is pending.

Bartell, meanwhile, said the company will consider shutting down Medicaid business at other stores.

The company's decision is related to a court settlement in Massachusetts that has had a ripple effect around the country.

The amount private insurers and Medicaid pay pharmacies for prescriptions isn't the actual cost of those drugs. Instead, the rates often are based on what's called the drug's estimated average wholesale price.

But that figure is more like the sticker price on a car than the actual wholesale cost of those drugs. Washington reimbursed pharmacies the actual wholesale price minus 14 percent until July, when it began reducing reimbursements to 16 percent.

Pharmacies weren't happy about that. Then, in September, came another blow. The adjusted wholesale price is calculated by a private company, which was accused in a Massachusetts lawsuit of fraudulently inflating its figures. The company did not admit wrongdoing but agreed to ratchet its figures down by about 4 percent. That agreement took effect in September.