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Rx groups hail Medicaid ruling

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ARLINGTON, Va. — In a show of solidarity, the National Association of Chain Drug Stores (NACDS), the Washington State Pharmacy Association (WSPA) and the National Community Pharmacists Association (NCPA) welcomed a recent court decision that confirmed the pharmacy reimbursement plan for the state of Washington violates Medicaid rules.

Steve Anderson

Steve Anderson, NACDS

The pharmacy groups are also urging the federal Centers for Medicare and Medicaid Services (CMS) to bring to an end to the state’s “flawed” plan.

The court’s ruling upholds a March 2019 decision from CMS that essentially came to the same conclusion regarding the state’s reimbursement process. The CMS decision was then challenged by Washington State. The recent court decision, however, brings the matter one step further to wrapping up a lawsuit filed in March 2017 by NACDS, WSPA and NCPA against the state and its plan.

“On behalf of Washington State Medicaid patients and the pharmacies and pharmacists serving them, we want to express appreciation for the decision of Benjamin Cohen, who reviewed the matter on administrative appeal. We urge CMS to continue to enforce compliance with the federal regulations and adopt the Administrative Law Judge’s recommendation to uphold denial of Washington State’s below-cost Medicaid pharmacy reimbursement plan that jeopardizes patient access and pharmacy viability alike,” stated NACDS, WSPA and NCPA in a joint release. “The events of the past four years related to Washington State’s Medicaid pharmacy reimbursement have demonstrated clearly that compliance with Medicaid reimbursement rules is mandatory.”

The roots of the lawsuit go back to 2016 when CMS put in place a new rule changing how states must reimburse pharmacies. A key part of that rule indicates that states must reimburse pharmacies for their actual costs in dispensing drugs to Medicaid beneficiaries. Since CMS put the new rule in place, Washington State, according to NACDS, WSPA and NCPA, failed to comply with the rule by maintaining its below-cost dispensing fees. The three pharmacy groups emphasized throughout the challenge that Washington State refused to adopt cost-based dispensing fees, and maintained below-cost dispensing fees — lower than any state in the country — which may impede patient access to care.

In other news concerning drug costs, t leading pharmacy groups, including NCPA, the American Pharmacists Association, the National Association of Specialty Pharmacy, FMI – The Food Industry Association and the National Grocers Association, recently issued a rebuke to the Trump administration’s new final rule on prescription drug rebates.

“While we want our patients to pay less for their prescription drugs, this rule does not accomplish that,” the groups stated, adding that the ruling will likely increase insurance premiums and out-of-pocket costs and may limit patient access to care by forcing more pharmacies to close.

The groups went on to state that they have “repeatedly provided evidence” that any action on prescription rebates must also address pharmacy DIR (direct and indirect remuneration) fees. Pharmacy DIR fees are causing patient prescription drug costs to skyrocket while limiting patient access to care and forcing more pharmacies to shut down.

The pharmacy organizations also noted that they have previously weighed in on the possible dire impact of rebate reform on pharmacies — “namely late payments, lack of transparency to pharmacy reimbursement or chargeback amounts at the point of sale, unclear regulatory oversight, and costs associated with implementing such system outlined in the final rebate rule.” Without pharmacy DIR fee reform, the groups contend, the impact of implementing a system to pass rebates on to patients at the pharmacy counter may prove disastrous for patients and pharmacies.


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