This fall, the U.S. Supreme Court is slated to hear a case examining the right of pharmacies and other health care providers to challenge state cuts to Medicaid on the basis that they violate federal requirements for "sufficient" patient access to health care.


Douglas v. Independent Living Center of California, U.S. Supreme Court, pharmacy groups, pharmacies, health care providers, Medi-Cal, Medicaid reimbursements, California, National Association of Chain Drug Stores, NACDS, National Community Pharmacists Association, NCPA, American Pharmacists Association, APhA, National Alliance of State Pharmacy Associations, NASPA, Medicaid reimbursement cut, Steve Anderson, B. Douglas Hoey, Thomas Menighan, Rebecca Snead, Medicaid pharmacy reimbursement, pharmacy care, payment rates, Medicaid patients, pharmacist, Russell Redman, Alliance for Patient Care, APC, Pharmacy Choice and Access Now, PCAN, California Retailers Association, Centers for Medicare & Medicaid Services, CMS
































































































































































































































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Pharmacy groups challenge planned Medicaid cuts in Supreme Court brief

August 8th, 2011

ALEXANDRIA, Va. – This fall, the U.S. Supreme Court is slated to hear a case examining the right of pharmacies and other health care providers to challenge state cuts to Medicaid on the basis that they violate federal requirements for "sufficient" patient access to health care.

The National Association of Chain Drug Stores (NACDS), National Community Pharmacists Association (NCPA), American Pharmacists Association (APhA), and  National Alliance of State Pharmacy Associations (NASPA) late last week filed a legal brief with the Supreme Court in the case of Douglas v. Independent Living Center of California.

According to NACDS, the case centers on a plan by the state of California to reduce Medicaid reimbursements to health providers, including pharmacies. The initial lawsuit, filed by pharmacies and other health providers, contends that a 10% Medicaid reimbursement cut in California violates the federal patient access law, which mandates that Medicaid reimbursement rates must be "sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in the geographic area."

The pharmacy groups claim the proposed cuts threaten access to care for Medicaid patients. Payment rates have become so low in many parts of the nation that it has become difficult for Medicaid patients to find health care providers that will take them.

"We are deeply troubled about the impact that such a drastic cut in Medicaid pharmacy reimbursement will have on patient access to pharmacy care," NACDS president and chief executive officer Steve Anderson said in a statement. "This short-sighted proposal is not the solution to cutting spending and reducing costs. We have and will continue to urge the state to work with pharmacy and other provider groups to find cost-effective alternatives that do not jeopardize Medicaid beneficiaries' access to health care services."

B. Douglas Hoey, executive vice president and CEO at NCPA, noted that patients rely on  local pharmacists for medication counseling and advice on controlling health care costs. "Independent community pharmacists, in particular, are often located in underserved rural and urban areas where there may be few, if any, other pharmacy options," he explained. "These cuts clearly jeopardize pharmacy access for underserved patients and could ultimately increase costs."

The brief filed by the pharmacy groups also invokes the legal principles of the Consitution's Supremacy Clause, in which federal law supersedes state law. The groups argue that a "long line" of Supreme Court decisions support the right to challenge state actions inconsistent with federal laws and, therefore, challenges to insufficient Medicaid reimbursement rates must be allowed if they threaten patient access to pharmacy care.

"We share our colleagues' deep concern with Medicaid cuts that will dramatically impact patient access," stated Rebecca Snead, executive vice president and CEO at NASPA. "Arbitrarily implementing reductions in Medicaid reimbursement without consideration of federal law is a disservice to its beneficiaries who rely and depend on these services. Ultimately, these drastic cuts will put their health and lives at risk."

NACDS reported that the Supreme Court will hold a hearing on the case Oct. 3 and may issue a decision later this year.

"While we recognize the budget constraints that states face, these proposed Medicaid cuts will exacerbate our medication use crisis by forcing more pharmacies out of Medicaid and disrupting patient/pharmacist relationships that are critical to effective medication use," commented Thomas Menighan, executive vice president and CEO at APhA. "The data show that poor medication use leads to higher costs in the form of emergency department visits and hospitalizations."

Opposition to the proposed cutbacks in California's Medicaid program, known as Medi-Cal, has been building in recent months.

Last week, a coalition of health care providers and pharmacists called the Alliance for Patient Care (APC) went to Capitol Hill to urge the Centers for Medicare & Medicaid Services and Congress to reject the planned reductions to Medi-Cal.

And in July, NACDS and the California Retailers Association submitted a letter to CMS calling on the agency to strike down California's state plan amendment to cut Medi-Cal reimbursements to pharmacies and other health providers. The same month, a coalition dubbed Pharmacy Choice and Access Now (PCAN) that included pharmacists, businesses and consumers urged the Department of Health and Human Services and CMS to deny the enactment of the proposed Medi-Cal cuts, saying the move would significantly reduce health care access in California.  

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