Pharmacists appeal new rules
Lawmakers join opposition to cuts in Medicaid reimbursement
By Marsha Shuler
Capitol news bureau
September 14, 2012
Legislators joined community pharmacists Wednesday in pushing the Jindal administration to scrap new Medicaid reimbursement rules, which they said threaten the health care providers’ businesses.
Opponents asked state health officials to cease using the rules and go back to the drawing board on proposed budget reduction measures. The sometimes fiery public hearing attracted more than 200 people.
“We ought to roll back to what it was because this is not working,” said Peter Wolfe, a pharmacist from Chauvin. “You are punishing us. We need to be rewarded for the job we are doing.”
“You are telling us that what we do is worth zero profits,” said Nikki Hollier, of Hollier’s Family Pharmacy, in Breaux Bridge.
“I don’t think you can expect these folks to keep losing money every day,” said state Sen. Bodi White, R-Central.
State Department of Health and Hospitals Undersecretary Jerry Phillips, who got the brunt of the angry words, said all suggestions for change would be taken into consideration. But he said he could not promise to roll back the reimbursement rules “because of the budget.”
DHH’s budget requires a $56 million savings in the pharmacy roll. The reimbursement change is part of the cut plan.
But Phillips said: “We are going to work with you.”
“Jerry, you have been doing this long enough. You know this is a pile of crap,” shouted Robert Toups, a retired pharmacist from Cutoff.
Later, DHH Secretary Bruce Greenstein, who was in New York speaking to a health care reform group, said in a telephone interview: “There’s no reason to change ... They are asking us to pay them more than chain drug stores for doing the same thing.
“If their (financial) data is so compelling and it makes sense in the overall scheme, we can make some amendments to the rule, but it’s got to work out for the benefit of taxpayers and it’s got to help us balance the budget,” he said.
Under the new policy, DHH is reimbursing for the average acquisition cost plus $10.13 per prescription. The independent pharmacists said they have to pay far more than the average cost that DHH has affixed to the drugs included in the program. Chain pharmacies can use prescription drugs as a loss leader because they are big stores with more products to sell, they said.
The pharmacists said officials relied on bad information from their financial advisers in setting the policy as well as average acquisition costs of drugs. They said special circumstances that exist with independent or community pharmacies have not been taken into account.
“The change in reimbursement gives them some fear” that DHH is trying to achieve the entire $56 million savings from the one policy change, said Randal Johnson, president of the Louisiana Independent Pharmacies Association.
DHH held the public hearing to get feedback on the rule as well as to update the pharmacists on changes to plans that move pharmacy coverage management into Bayou Health, the state’s private insurance based health care delivery system for the poor.
DHH executive assistant Calder Lynch told the crowd that the changeover would not occur until Nov. 1 — about a month later than anticipated.
State Sen. Ronnie Johns, R-Sulphur, said the five legislators in the room favored rolling back the reimbursement rule with DHH working with pharmacists on a revision to be implemented Nov. 1 along with Bayou Health changes.
“Why can’t you roll out the whole thing at the same time,” Johns asked.
State Sen. Fred Mills, R-St. Martinville, said pharmacists helped DHH develop policies that have driven the prescription drug program costs down — from $554 million in net expenditures in 2010 to $450 million in 2012 — an $83 million savings.
“This legislative group here hears you loud and clear,” Mills said. He said pharmacists are saying, “I can’t take it any more. I’m done.”