Below-Cost Reimbursements Concern Community Pharmacists


With prescription drug prices rising above reimbursement rates, many pharmacists are seeing patients struggle to access generic drugs.

With prescription drug prices rising above reimbursement rates, many pharmacists are seeing patients struggle to access generic drugs.

A new survey of 700 community pharmacists conducted by the National Community Pharmacists Association (NCPA) revealed a growing concern over generic drug costs. Some of the survey’s key findings include:

  • Almost all community pharmacists reported a “large upswing” in the acquisition cost of a generic drug over the past 6 months, with approximately 80% stating this occurred in at least 26 instances during this period, and 27% indicating this happened more than 100 times.
  • 87% of pharmacists said it took at least 1 month for reimbursement rates to adjust in accordance with an increased generic acquisition cost, while 10.5% of pharmacists noted the reimbursement rates were never adjusted.
  • Nearly 57% of pharmacists reported their appeals to adjust the maximum allowable costs (MACs) were rejected, while almost 26% of pharmacists did not receive a response to their appeals at all.
  • 93% of pharmacists believe the situation has grown worse since 2013, when the NCPA conducted a previous survey on the issue.

“For decades, community pharmacists have promoted the appropriate use of generic drugs to lower costs,” said NCPA CEO B. Douglas Hoey, RPh, MBA, in a press release. “However, more recently, the price for some of these medications has skyrocketed 1000% or more virtually overnight while reimbursement rates paid to community pharmacists have inexcusably lagged behind for weeks or months.”

Urging federal and state lawmakers to take action, Hoey noted escalating drug costs have serious repercussions for both pharmacists and patients.

“Community pharmacies cannot be expected to continually fill many prescriptions at a significant loss,” Hoey said. “…Some patients are already skipping medication due to higher prices and co-pays or are forced into the Medicare coverage gap or donut hole sooner. Others will likely find it more difficult to find certain generic drugs at all because their pharmacy can no longer afford to stock and dispense them.”

The most frequently cited generic medications for which pharmacists receive below-cost reimbursements include benazepril, clomipramine, digoxin, divalproex, budesonide, haloperidol, hydroxychroloquine, levothyroxine, methylphenidate, morphine, nystatin/triamcinolone, pravastatin, tamsulosin, and tizanidine.

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