Many owners of the state’s more than 500 independent pharmacies and smaller chains — including those in the Springfield area — are being paid less than the “acquisition cost,” or wholesale price, of the medicines they dispense to Medicaid patients.
[Garth Reynolds, executive director of the Illinois Pharmacists Association] said pharmacies also have seen their per-prescription “dispensing fee” from Medicaid — designed to cover professional services — drop from $5.50 for generics and $2.40 for brand-name drugs under the previous “fee-for-service” system to the current 45 cents per prescription.
As a result, many pharmacy owners say their overall payments from Medicaid have dropped by half or more because of rate cuts instituted by companies known as pharmacy benefit managers, or PBMs.
At least one of those PBMs, CVS Caremark, pharmacy benefit manager for the huge CVS Pharmacy chain, appears to be working with CVS Pharmacy to put smaller pharmacies out of business so CVS can acquire them, Reynolds said.
“It’s kind of a predatory market practice and misuse of state tax dollars,” he said.
* Many problems are surfacing about these pharmacy benefit managers. And it’s not confined to Illinois…
Did you know that for every 60-mg caplet of duloxetine dispensed in Ohio through a Medicaid-contracted managed-care company, taxpayers pay a middleman $1.54, but the middleman passes only about 18 cents of that to the pharmacy that supplies the drug and pockets the $1.36 difference?
* Check this out…
CVS’s benefit manager cut Medicaid reimbursements to local Ohio pharmacies this past fall, which some say put them in financial jeopardy. Then CVS’s “acquisition unit” sent letters to many of those same pharmacies, saying times are tough and asking whether they would be interested in selling their business.
That appears to be happening in Illinois as well.
* Illinois legislators are being flooded with calls from their local pharmacists who are worried they’re about to go out of business…
Kate Gainer of the Iowa Pharmacy Association encouraged lawmakers to further investigate pharmacy benefit managers, saying they engage in unfair practices that go largely unregulated. Gainer blamed the contracts for the closure of dozens of pharmacies across Iowa.
More background is here.