Below-cost Rxs: One state just says no

It happens everyday at pharmacies: A patient arrives with a prescription. The drug is in stock. However, the reimbursement the patient’s insurance pays for filling the prescription is less than what it cost the pharmacy to acquire the drug.

Usually, the pharmacy has no choice but to take the loss, as the pharmacy benefits manager (PBM) or the patient’s insurer dictates reimbursements as part of the privilege of the pharmacy being in its network. Other times, the pharmacy does not even know what it will be reimbursed until after the claim is processed.

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Gov. Phil BryantStarting in July, a new law in Mississippi will allow a pharmacy to refuse to provide drugs or services if it is not paid more than acquisition cost. Sponsored by Sam Mims (R-McComb), Mississippi Gov. Phil Bryant recently signed the bill into law.

If a pharmacy declines to dispense a drug, the pharmacy must provide the customer with information on where their prescription can be filled.

Supporters of the law, especially independent pharmacists, believe it will help them stay in business. But the nation’s largest pharmacy benefit manager, Express Scripts, said the law reduces patient care and access.

“It is unfair for pharmacies to put profits ahead of people and turn away patients who need medication. The burden should not fall to the patient or payer if a pharmacy is not a good purchaser of drugs,” Brian Henry, an Express Scripts’ spokesperson, told Drug Topics.

“Our job is to work with payers ­ employers, health plans, unions and others ­ to build quality, cost-effective pharmacy networks so that patients have broad access to medicine they need,” Henry said.

Robert H. Dozier, executive director of the Mississippi Independent Pharmacies Association, said the law is not a cure-all for one-sided contracts dictated by PBMs.

“An independent pharmacist is a small business owner. But he or she is also a healthcare provider,” Dozier said. “At the end of the day, most pharmacists are going to take a loss instead of denying someone medication they need.”

Dozier said usually pharmacies must process a claim before they even know what they’ll be reimbursed. He called the law a tool that might help pharmacies negotiate better reimbursement rates.

“The PBMs like to say they negotiate prices. They really don’t negotiate anything,” Dozier said.

The state’s Board of Pharmacy has been directed to establish rules for complying with the new law, including guaranteeing access to pharmacy services in rural and underserved areas. The board has been given an Oct. 1, 2016 deadline.