Fair Pharmacy Reimbursement a Result of Health Reform


New research concerning a provision of the Affordable Care Act confirms its benefits for community pharmacists.

Although the verdict is still out on health reform, at least one component of the Affordable Care Act is earning praise from pharmacy advocates. According to a report released by the Government Accountability Office (GAO), the law ensures fair pharmacy reimbursement for generic drugs under Medicaid.

Responding to the report, Kathleen Jaeger, executive vice president and chief executive officer of the National Community Pharmacists Association (NCPA), said the bipartisan provision “struck the right balance” and will enable local independent pharmacists to continue serving Medicaid patients.

“The policy helps state and federal officials grappling with rising Medicaid costs, while preserving patient access and avoiding the draconian cuts that were previously enacted,” she said. She thanked representative Henry Waxman (D, CA) for championing the provision and ensuring its inclusion in the Affordable Care Act.

In their analysis of 40 high-volume drugs, GAO found that the new Medicaid payment rates would be sufficient to cover generic drug acquisition costs. The report stated that for most of the drugs in their sample, federal upper limits for reimbursement were lower than they were before health reform and higher than average retail pharmacy acquisition costs.

“This is a great example of the important improvements made possible through the health care reform law,” Waxman said. “The law averted massive payment cuts to pharmacists for generic drugs under Medicaid, and did so in a responsible way for taxpayers.”

Although the new reimbursement policy is a step in the right direction, Jaeger said more must be done to create policies that will preserve patient access to health care provided by local independent pharmacists. “Simply reimbursing for acquisition costs alone wouldn’t allow these small businesses to make ends meet,” she said.

NCPA will continue collaborating with lawmakers to identify legislative solutions that benefit patients, pharmacists, and the health care system. “Community pharmacists are ready and willing to work with policymakers to find cost savings, improve outcomes and preserve patient access and choice,” Jaeger said.

For other articles in this issue, see:

  • Seniors Taking Antidepressants at Risk for Drug Interactions
  • Grant Targets Dwindling Options for Pharmacy Grads
  • Part D Plan Selection Poses Challenge for Patients
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