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Legislators want to know why $10 million in emergency assistance hasn’t been distributed

Thursday, Sep 13, 2018

* Background is here and here. Doug Wolfe at WAND TV

State Senator Andy Manar, (D) Bunker Hill, and two other Illinois lawmakers are demanding answers from the Rauner administration concerning funds for critical access pharmacies.

The legislature created the critical access pharmacy program (Public Act 100-587; HB 3342) with the intention of providing funds for the sustainability of independent pharmacies that have been negatively impacted by reimbursement rates through the states managed care program. The new managed care program started April 1, 2018. Since that time several pharmacies throughout the state have closed including pharmacies in Mt. Zion and Lincoln.

A September 10, 2018 letter was sent to Patricia Bullock, Acting Director of the Illinois Department of Healthcare & Family Services, seeking an explanation as to why the program has not been implemented. The letter from Senator Manar, Senator Heather Steans, (D) 7th District and Representative Gregory Harris, (D) 13th District, reads in part:

“While this program is subject to appropriation, the fiscal 2019 budget as contained in Public Act 100-586 (HB 109) included $10,000,000 to fund disbursements to critical access pharmacies. We strongly believe that this program needs to be administered as soon as possible to prevent pharmacy closures that would impact access to care for individuals throughout the state – closures that are occurring right now in Illinois.”

* I asked the Rauner administration for a response and was sent this…

In following recently enacted state law, the Department has been working with stakeholders to establish this new program in a way that will ensure it offers as much assistance as possible. HFS is developing program guidelines within the timeline of the formal rule-making process that needs to be followed.

I asked what that timeline was and didn’t hear back. Manar’s letter also asked for a timeline.

I sent the administration’s response to Manar. His spokesperson sent me this…

Just talked to him. He noted that this is an emergency situation for these pharmacies and that the budget went into effect July 1. He said, “We have not received a response, and we would have expected them to at least have rule-making started by now.”

* Meanwhile in Ohio

Ohio’s Department of Medicaid will end the state’s contracts with pharmacy benefit managers which bill taxpayers more than they reimburse pharmacists for filling Medicaid patients’ prescriptions.

The department on Tuesday directed Ohio’s managed care plans to terminate contracts with pharmacy benefit managers, or PBMs, based on the “spread pricing” practice, The Columbus Dispatch reported. The state said it’s moving to a more transparent pass-through pricing model Jan. 1.

- Posted by Rich Miller        

18 Comments
  1. - wordslinger - Thursday, Sep 13, 18 @ 10:31 am:

    Squeeze the beast, by any means possible.

    Tell us more, governor, about how every small business in the state endorsed you.


  2. - 47th Ward - Thursday, Sep 13, 18 @ 10:33 am:

    ===Bullock===

    It’s Bellock, but close enough for TV I guess.


  3. - Rich Miller - Thursday, Sep 13, 18 @ 10:34 am:

    ===It’s Bellock===

    Oh, so you’re reading the posts now? lol


  4. - 47th Ward - Thursday, Sep 13, 18 @ 10:37 am:

    Lol. I read, just not for comprehension.


  5. - Annonin' - Thursday, Sep 13, 18 @ 11:12 am:

    Seems like GovJunk does not count as “Lessons Learned” that emergencies found in May(or earlier) leads to rules in September.


  6. - Precinct Captain - Thursday, Sep 13, 18 @ 11:18 am:

    Everyday Rauner’s incompetence becomes more astounding.


  7. - Anonymous - Thursday, Sep 13, 18 @ 11:28 am:

    Correct me if I am wrong, but the “Critical access care pharmacy” as written was for any pharmacy that is located in a county with fewer than 50,000 residents. The pharmacy in Mt Zion would not have been eligible for this.

    HB3342 Enrolled
    - 439 -
    LRB100 08528 SMS 18653 b

    1

    pharmacies.


  8. - The Way I See It - Thursday, Sep 13, 18 @ 11:36 am:

    Taking time figuring out which middleman is going to get a slice of pie takes time …


  9. - Annonin' - Thursday, Sep 13, 18 @ 11:50 am:

    Speakin’ of Lessons Learned GovJunk rollin’ out pork this afternoon too.
    Elgin Community College, McHenry County College to receive money for repairs
    9/11/2018

    Millions of dollars in capital funding have been released by the Illinois Office of Management and Budget to community colleges across the state. State Senator Donald P. DeWitte (R-St. Charles) says two local colleges, Elgin Community College and McHenry County College, will receive thousands from the Fiscal Year 2019 capital budget.

    “The money these colleges will receive was included in this year’s budget and is critical in order for them to move forward with much-needed repairs and updates,” said DeWitte. “Our community colleges provide a great educational path for many students in our area, making it extremely important that we invest dollars toward their improvement needs.”

    Elgin Community College will receive $435,725 and McHenry County College will receive $153,130 in state funding. In addition, both colleges will receive local funds bringing their totals to $1,000,000 and $800,000 respectively.

    DeWitte says the funds received by Elgin Community College will go toward the purchase of a new chiller for Building B, and funds received by McHenry County College will go toward repairing roof top units, installing new installation, and replacing duct work.

    See below for funding amounts:


  10. - dbk - Thursday, Sep 13, 18 @ 11:51 am:

    I’m not sure such delays indicate incompetence, given that they result in closures, which might in fact be the desired result.

    It’s hard to tell.


  11. - The Dude Abides - Thursday, Sep 13, 18 @ 11:55 am:

    The question is this just more incompetence by this Administration or are they intentionally foot dragging on this?


  12. - pharm-assist - Thursday, Sep 13, 18 @ 12:12 pm:

    Even though pharmacy reimbursements (dispensing fees) have been dropped to $0.42 a prescription from $5.50, and the livelihood of family owned businesses are at stake, resulting in less access to pharmaceutical care, we are still making the main focus on how much the Medicaid MCO’s are overcharging the state, thru spread pricing and how everyone is losing but the PBM’s.


  13. - illini - Thursday, Sep 13, 18 @ 12:35 pm:

    @pharm-assist - This is exactly why my niece will never own or work for any local retail pharmacies. Her focus has moved so far from this aspect of the business that she even dreads having to do a rotation in this part of her profession certification. And after she does another 2 years in a residency she never expects to be involved with the types of games many in the retail end of the business have to contend with.


  14. - PharmLifer - Thursday, Sep 13, 18 @ 12:36 pm:

    As Anonymous said above the law does state a minimum population of 50,000 in the county. HOWEVER, if you keep reading the same law allows the Department to include pharmacies in need of assistance that are located in counties that exceed the population limit. This allows the Department to actually help the pharmacies that have gotten nailed the hardest by these contracts,
    Keep in mind, the state is losing MILLIONS and MILLIONS of dollars to mismanaged funds to these MCO contracts because there are NO LAWS overseeing how the PBM’s operate in this state. They can charge the state whatever they want and pay the pharmacies whatever they want and they don’t have to report the spread they make. Don’t you think these state paid contract holders should have to show their books? Don’t you think the State Medicaid program should not be set up to put PROFESSIONALS out of business?

    Answer this: If you are a patient expecting a pharmacist to fill your prescription. How much VALUE would you put on making sure the prescription is filled correctly, at the right dose for you or even your child, doesn’t interact with all your other meds, and then don’t forget the mandatory counseling that pulls the pharmacist aside from filling the next script to explain all the details and how to take it. How much would you think that service is is worth from a professional medical degree pharmacist? It’s less than a buck. To save your life. Let that sink in.


  15. - illini - Thursday, Sep 13, 18 @ 12:56 pm:

    @PharmLifer - well said. Are people reading and comprehending your cogent points?


  16. - sharkette - Thursday, Sep 13, 18 @ 1:13 pm:

    I’d ask the Cantroller why she hasn’t paid any one.
    She’s stock piling tons of cash out of tons of funds. Maybe audit what she actually doesn’t do with the funds.
    Or maybe she is going to use it to pay step up raises to employees due back to 2015,, pus interest.. Instead of the Vendors…again


  17. - taxpayerx - Thursday, Sep 13, 18 @ 2:43 pm:

    @anonymous, the MTZ pharmacy owner owns pharmacies in several rural counties in Central & Southern IL that qualify under the original designations for critical pharmacies.

    Also, every IL taxpayer should be interested in this, as West Virginia has already kicked Pharmacy Benefit Managers out of their state Medicaid system, and saved $38 Million the first year (2017). Gov Rauner wants to believe his medicaid expansion has helped people, but it limits access to healthcare when pharmacies are closing due to spread pricing games and local hospitals don’t accept all plans.

    Ohio, North Dakota, Kentucky & Arkansas have already figured out the PBM spread pricing scheme, and are working to save their taxpayers $$.


  18. - taxpayerx - Thursday, Sep 13, 18 @ 2:51 pm:

    @sharkette, the comptroller can’t disperse the critical pharmacy funds until HFS gets their head out of the sand and starts moving. There has been ZERO progress on this since July. Pharmacies already went 2 years without state payments during the budget stalemate from 2015-2017.

    Where are the rest of our legislators on this??


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