“CMS has taken action that is consistent with the Covered Outpatient Drugs final rule and that is consistent with the health and wellness of our most vulnerable patients.”
Central to this issue is a new rule put into place by CMS in 2016, which changed states’ calculation of reimbursement to pharmacies for Medicaid prescriptions. A key part of the rule indicates that states must at least reimburse pharmacies for their actual costs in dispensing drugs to Medicaid beneficiaries. The associations have advocated in all branches and levels of government that Washington State’s below-cost reimbursement violates the new rule, jeopardizes reliable patient access to medications responsible for ensuring patient health, and leads to more costly forms of care that result from untreated conditions.
This action by CMS should spur Washington State to increase its dispensing fees and demonstrate to other Medicaid programs that dispensing fees must cover pharmacies’ costs. This increase in dispensing fees must be supported by pharmacy cost data, and under federal rules should be applied retrospectively effective April 1, 2017. The State has indicated it plans to ask CMS to reconsider its decision.
NACDS, WSPA, and NCPA issued a joint statement in support of CMS’ decision: “CMS has taken action that is consistent with the Covered Outpatient Drugs final rule and that is consistent with the health and wellness of our most vulnerable patients. We strongly support this pivotal development, which will prove highly significant for pharmacy patient care in Washington State and nationwide. We will continue to advocate in support of this pro-patient and pro-pharmacy position.”
In June of this year, NACDS, NCPA, and WSPA sent a letter to CMS asking the agency to “delay no longer in requiring Washington to comply with federal Medicaid reimbursement law like other states.”
Previously, in March 2017, NACDS, WSPA, and NCPA sued the State of Washington to stop a “substantively and procedurally flawed” rule that would pay community pharmacies below the actual cost to dispense Medicaid prescriptions. An important brief filed this summer in the Washington State Court of Appeals described the associations’ position in great detail. NACDS, WSPA and NCPA are continuing their litigation challenging the state’s inadequate dispensing fees.
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NACDS represents traditional drug stores, supermarkets and mass merchants with pharmacies. Chains operate over 40,000 pharmacies, and NACDS’ nearly 100 chain member companies include regional chains, with a minimum of four stores, and national companies. Chains employ nearly 3 million individuals, including 152,000 pharmacists. They fill over 3 billion prescriptions yearly, and help patients use medicines correctly and safely, while offering innovative services that improve patient health and healthcare affordability. NACDS members also include more than 900 supplier partners and over 70 international members representing 20 countries. Please visit NACDS.org.
The Washington State Pharmacy Association (WSPA) represents pharmacists, technicians, and interns practicing within community pharmacies, clinics, nursing homes and hospitals. WSPA members provide care to Medicaid patients throughout Washington’s urban, rural and underserved communities. Please visit www.wsparx.org.
Founded in 1898, the National Community Pharmacists Association is the voice for independent pharmacy, representing 22,000 pharmacies that employ more than 250,000 individuals nationwide. Independent pharmacists are rooted in the communities where they are located. Pharmacists are America’s most accessible health care providers. To learn more, go to www.ncpanet.org.