Holding Pharmacy Harmless

So while the epilepsy bill remains simmering on the front burner, a second pot has started boiling over.  The issue: reimbursement.  When ruling against Medispan and First Data Bank’s inappropriate increase in brand name drug average wholesale prices (AWP) took effect, the AWP of these drugs dropped about 4%.  The AWP serves as a reimbursement benchmark; payors will reimburse pharmacies at AWP minus a certain percentage.  Most payors recognized the need to adjust reimbursement to maintain pharmacy whole.  Minnesota Medicaid did not make an adjustment in reimbursement leading MPhA to file a lawsuit in order to maintain reimbursement levels.  This was not successful and Medicaid has not adjusted reimbursement rates. 

At one point in my educational career, I spent some time at Medicaid.  Although the focus of my time there was drug utilization review, I got a peek into the money matters.  It’s a fine line to walk; as you are responsible to the people you serve: beneficiaries of health services and those who pay taxes.  The decisions you make create waves affecting the physical health of one group and the financial health of the other. 

So when I first encountered this issue, I was glad that Medicaid had a few more dollars to help a few more patients.  I mean, in my eyes it was patients who needed help.  I have seen health disparities first hand and I don’t think they should happen here.  But here’s the catch: in this rotation I get to speak to a wide variety of people who practice pharmacy.  I’m learning everyday what the financial implications are to pharmacies.  If pharmacies are losing money on transactions, how will they be able to survive?  When pharmacies go, so does access to health care; that trumps any good intentions of mine to pass along a few bucks to the people. 

MPhA is working on a bill (HF 3266) to keep reimbursements at the same level before the Medispan/FDB lawsuits.  Its intention is not to increase profit but to hold pharmacy harmless, to ensure pharmacies they will be able to stay open and serve the people of this community.  So in pursuit of fully grasping the situation, I would like to hear from those affected.  How is your pharmacy managing, or is this blip not even on you radar screen?  Let me know.