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Lawsuit aims to derail Washington state pharmacy regs

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OLYMPIA, Wash. — The National Association of Chain Drug Stores has joined the National Community Pharmacists Association (NCPA) and Washington State Pharmacy Association (WSPA) in suing Washington state over a rule they say would reimburse pharmacies for less than the cost of dispensing Medicaid prescriptions.

The plaintiffs last month filed an emergency motion in Superior Court of the State of Washington (Thurston County) to halt what they called a “substantively and procedurally flawed” rule. They claim the measure would imperil access to necessary medications, raising the prospect of the need for more costly forms of care.

“This motion seeks to halt further reimbursement cuts until such time as the state properly implements Medicaid reimbursement rates that cover the actual costs that pharmacies incur when they serve Medicaid patients, as required by law,” NACDS, NCPA and WSPA wrote in the motion. Also filed by the groups was a petition for declaratory relief and emergency stay.

At issue is rule WSR 17-07-001 of the Washington State Health Care Authority, which the associations said changes how the agency calculates pharmacies’ acquisition cost for drugs and pares Medicaid reimbursements. They noted that the state’s rule doesn’t make adjustments to account for the professional dispensing fee — contrary to a federal rule from the Centers for Medicare and Medicaid Services.

The dispensing fee must cover actual costs to fill the prescription, yet the fee in Washington state is much lower than the cost identified in studies conducted by other states and experts, according to NACDS, NCPA and WSPA. An independent study commissioned by NACDS and NCPA found that the cost of dispensing in Washington is more than double the proposed professional dispensing fee for Medicaid prescriptions in the new rule.

The plaintiffs also claim that Washington violated rule-making procedures. They said the state informed pharmacies after the formal comment period and after it issued the final rule that dispensing fees wouldn’t be adjusted, thereby not giving pharmacies sufficient opportunity for comment.


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