The third advocacy issue identified by NCPA members was not among the top priorities for 2017, but is high on members’ radar now. Community pharmacies across the nation have started seeing dramatic reimbursement cuts in Medicaid managed care plans, a serious financial blow to community pharmacies. The cuts may undermine a CMS directive that states must establish time and distance network adequacy standards for providers, including pharmacies, under managed care contracts and ensure continuity of care for beneficiaries on or after July 1, 2018. Community pharmacies ability to participate In Medicaid is endangered by these unsustainable cuts.
Because Medicaid is largely a state function, NCPA is working with state partners to ensure CMS’ network adequacy standards are being met. Managed care organizations should reimburse pharmacies at fee-for-service Medicaid pharmacy reimbursement rates. PBMs are currently running these tax payer-funded plans like commercial plans, where transparency and accountability are lacking. That must change. NCPA will continue to engage with CMS and other stakeholders to ensure pressure is applied to right this hardship.
In addition, NCPA is supporting states identifying savings in state Medicaid contracting. For example, West Virginia’s state Medicaid agency carved the prescription drug benefit out of Medicaid managed care last year. They did this based on a study that showed Medicaid could save $30 million annually by administering the benefit directly, which would also put $34 million back into local economies in the form of pharmacy reimbursements.
NCPA’s sole focus is on community pharmacy owners. They have told us what’s on their minds and we’re carrying that message—and potential solutions—to Capitol Hill and beyond.
Dave Smith, RPh, is president of the NCPA.