As background, in 2016, CMS put in place a new rule changing how states must reimburse pharmacies. A key part of the rule indicates that states must reimburse pharmacies for their actual costs in dispensing drugs to Medicaid beneficiaries.
The legal brief asserts that Washington State has failed to comply with that rule, maintaining its below-cost dispensing fees. Since CMS released the rule, the “vast majority of states have adopted” cost-based dispensing fees, but Washington State has refused to do the same, maintaining the same below-cost dispensing fees—lower than any state in the country—which may impede patient access to care. Contrary to federal rules, the State argues that it does not need to “consider a pharmacy’s actual costs in determining dispensing fees.” To back up its decision to continue to impose insufficient dispensing fees, the State relies on a misreading of the requirements of the federal rule and inapplicable payment data from private insurance plans—which do not track actual costs, as required by the CMS rule.
The groups state in the brief that after more than three years of trying to work with Washington State, CMS should require the State to adopt cost-based dispensing fees and that such fees must be made effective April 1, 2017, according to regulation.
In June of 2018, NACDS, NCPA, and WSPA sent a letter to CMS asking the agency to “delay no longer in requiring Washington to comply with federal Medicaid reimbursement law like other states.” An important brief filed in the same month with the Washington State Court of Appeals described the associations’ position in great detail.
Previously, in March 2017, NACDS, WSPA, and NCPA sued the State of Washington to stop a “substantively and procedurally flawed” rule that would pay community pharmacies below the actual cost to dispense Medicaid prescriptions.