Federal Officials Push for Fair Medicaid Reimbursement

As a vote on the final health care reform bill draws nearer, 16 representatives and 9 senators are pushing for what they consider fair Medicaid reimbursement for generic drugs.

As a vote on the final health care reform bill draws closer, 16 representatives and 9 senators are working to ensure that provisions for sufficient Medicaid reimbursement for generic drugs are included.

“Community pharmacies play a critical role as primary health care providers in all communities across the United States and often serve as the only resource to millions of lower income Americans for their daily needs,” a letter from the representatives to House Speaker Nancy Pelosi (D, CA) stated. “Failure to adequately fix the Medicaid pharmacy reimbursement would directly impact these patients and the pharmacies that continue to serve them.”

The bipartisan group of representatives is pushing for Pelosi (D, CA) to consider an increased federal upper limit for Medicaid reimbursement. Despite existing provisions in the House and Senate reform bills that reduce the major cuts written into statute, but held up by court injunction, the legislators wrote, they are not convinced that the proposed reimbursement would be enough to preserve access to pharmacies for Medicaid patients.

The 9 senators are urging Senate Majority Leader Harry Reid (D, NV) to ensure that a Medicaid reimbursement provision remains in the final version of the Senate health care reform bill. Pushing for the conference report of the bill to set Medicaid reimbursements at a minimum of 175% of the weighted average manufacturer price (AMP), the group of senators is made up of Democrats.

Both the National Association of Chain Drug Stores and the National Community Pharmacists Association (NCPA) lauded the efforts, while voicing their own feelings about the importance of fair reimbursement.

“Cuts to Medicaid generic prescription drug reimbursement based on the AMP would force the community pharmacy to lose, on average, at least 36% on every such prescription they fill,” said Bruce T. Roberts, RPh, NCPA president and chief executive officer. “That will cause many community pharmacies to limit their participation, drop out of the program, or even go out of business.”