Lupin 2023

Rx groups file suits on Medicaid

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ALEXANDRIA, Va. — Groups representing community pharmacy have sued four states, saying that they are failing to provide Medicaid patients with access to the same care as everyone else.

According to lawsuits filed in federal court by the National Association of Chain Drug Stores, the National Community Pharmacists Association (NCPA), state pharmacy organizations and individual community pharmacies, the states of California, New York, Washington and Minnesota are violating federal law by not assuring that Medicaid patients receive access to and quality of care at least equal to that of patients in the general public.

The suits contend that after a federal judge ruled last month that First DataBank and Medi-Span could reduce their published average wholesale prices, the four states failed to follow a government-ordered mandate to adjust their reimbursement rates for prescriptions covered by Medicaid to ensure that pharmacies continued to be adequately compensated for filling these prescriptions.

“Some private payers and some states already have taken action to adjust reimbursements appropriately, to maintain the quality and accessibility of pharmacy patient care and its benefits,” NACDS president and chief executive officer Steve Anderson says. “Federal Medicaid law obligates the states to do the same.”

The pharmacy groups say the four states’ refusal to adjust their Medicaid reimbursement rates violates the Social Security Act. In addition, they claim that California, New York, Washington and Minnesota did not get the required government approvals for changes to their reimbursement rates.

The bottom line is that thousands of patients will suffer, the groups maintain.

“The failure to act by these states has produced a perverse outcome whereby underserved patients who need access to health care the most will get it the least,” comments NCPA executive vice president and CEO Bruce Roberts.

Anderson and Roberts say the states’ failure to adjust their Medicaid reimbursement rates has forced pharmacies in these areas to decide whether to fill prescriptions at below cost or turn patients away.

Below-cost reimbursement, they note, may result in pharmacies leaving the Medicaid program, reducing hours and services, or closing altogether, thereby threatening Medicaid beneficiary care and access.


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