The National Association of Chain Drug Stores and the California Retailers Association (CRA) have called on the Centers for Medicare & Medicaid Services (CMS) to reject a proposal to cut pharmacy reimbursement in California's Medicaid program.


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NACDS to CMS: Nix Calif. plan to cut Rx reimbursement

July 7th, 2011

ALEXANDRIA, Va. – The National Association of Chain Drug Stores and the California Retailers Association (CRA) have called on the Centers for Medicare & Medicaid Services (CMS) to reject a proposal to cut pharmacy reimbursement in California's Medicaid program.

NACDS said Wednesday that in tandem with CRA it submitted a letter to CMS urging the agency to nix a state plan amendment (SPA) proposed for Medi-Cal, California's Medicaid program, that would slash reimbursements to pharmacies and other health care providers by 10% as of June 1.

The association noted that California has previously proposed to scale back Medicaid reimbursements.

"We are deeply troubled by California's decision to submit this state plan amendment. In 2008, California submitted a similar SPA, proposing to cut the reimbursement of all Medi-Cal providers by 10%. Recognizing that this reduction would have threatened Medi-Cal beneficiaries' access to health care services, CMS rejected the SPA," NACDS and CRA stated in the letter.

"Rather than working with the provider community to develop alternate cost savings proposals, the state has again moved forward with this shortsighted proposal," the two associations said.

To help reduce Medi-Cal's costs, NACDS and CRA recommended that CMS consider such strategies as increased generic drug use to lower outlays for prescription drugs. The associations also pointed out that reduced access to prescription medications could end up hiking health care costs across the board, since untreated conditions typically lead to more costly forms of care. 

"By implementing policies that increase generic utilization, such as prior authorization and step therapy, and by working with pharmacies and other health care providers to improve medication adherence and coordinate the care of Medicaid beneficiaries with chronic conditions, the Medi-Cal program could control Medicaid spending without threatening Medicaid beneficiaries' access to healthcare services," the letter said.

Also on Wednesday, NACDS submitted comments to CMS on a proposed rule that would help to determine Medicaid beneficiary access to pharmacies and other health care providers.

The rule, NACDS explained, would create a process for states in determining compliance with the federal Medicaid access standard of the Social Security Act. In the letter, the association stressed that CMS to ensure access to health care services for Medicaid beneficiaries that's comparable to the access that the general population has in a given geographic area, which is a requirement of the federal standard.

"We applaud CMS for its efforts to create a standardized, transparent process for states to determine if they are meeting federal access requirements. We believe the three-part framework developed by the Medicaid and CHIP Payment and Access Commission (MACPAC) to assess access based on enrollees' needs, availability of care and providers and utilization of services will be a useful tool to determine where access problems may exist today and how to continue to monitor access," NACDS stated in its comments to CMS.

"We further commend the agency for its stated commitment to develop proposals for monitoring access in the managed care setting, as its use becomes more prevalent in the Medicaid population," the letter said.

NACDS also expressed its support for frequent reviews of beneficiaries' access to health care services and for the need for states to take corrective steps to address access issues. The association, too, called for more transparency and opportunities for public participation in reviewing beneficiary access and in changes to provider reimbursement rates.

"We believe maintaining an open dialogue between beneficiaries, providers, states and the federal government will lead to improved health care services for Medicaid beneficiaries," NACDS said in the letter.

 

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