Inside This Issue - News
Medi-Cal challenge to proceed
March 12th, 2012
WASHINGTON – The National Association of Chain Drug Stores and several other pharmacy associations are applauding a recent decision by the Supreme Court that sides with pharmacists and other health care providers in preserving their ability to challenge reimbursement cuts in Medi-Cal, California's Medicaid program.
The pharmacy groups previously filed a legal brief in this case, supporting the right of pharmacies to challenge Medicaid cuts that violate federal patient access law.
The decision is the result of a 2008 case filed in a federal district court in California that argued that a 10% Medicaid reimbursement cut in that state violates the federal patient access law, thus impacting access to care for Medicaid patients.
The Supreme Court’s decision ultimately sends the case back to an appeals court to determine whether health care providers may challenge Medicaid reimbursement cuts under the Constitution’s supremacy clause. That court had previously ruled that providers had standing to sue over reimbursement rate cuts.
“We applaud the Court’s decision ruling which favors preserving patient access to pharmacy care,” says NACDS president and chief executive officer Steve Anderson. “Ensuring patient access to pharmacy care should not be compromised in an attempt to remedy budget challenges.
“Community pharmacy provides unsurpassed value in improving health and reducing costs across the board. We appreciate the Supreme Court putting patients first with their decision.”
Still, the closely divided decision (5-4) failed to definitively side with pharmacists and the other health care providers. Instead, the justices cited the complexity of the cases and their changing circumstances. “It may be that not all of the considerations that may bear upon resolution of the issue have been presented,” said the majority opinion written by Justice Stephen Breyer.
But Chief Justice John Roberts, one of the four dissenters, argued that no provisions in the Constitution provide for private right of action in the case.
California spends over $41 billion a year on its Medicaid program (about 13% of the state’s budget), serving an estimated 7 million low-income individuals. In 2008 and 2009 the California legislature approved reimbursement reductions of between 1% and 10%.
The appeals court blocked the reductions from becoming effective and other reimbursement cuts have been subsequently legislated and then challenged in court. In October the Obama administration approved some of the proposed cuts, including a 10% reimbursement reduction for pharmacists and laboratory work.