When Marwan Hattab opened Wedgwood Pharmacy just over a year ago, he knew from his previous years in the business how much it costs to fill a prescription.
And he knows it's quite a bit more than he'll be paid under a new reimbursement system for Texas' Medicaid program. The state's move to managed care for Medicaid prescriptions goes into effect March 1, and Hattab and other independent pharmacists say they stand to lose money on every prescription they write for the federal/state healthcare program for the poor.A coalition of Texas pharmacies said last week that the dispensing fee that pharmacists receive for filing a Texas Medicaid prescription will plunge from about $6.50 to as little as $1.35.The change is part of legislation passed last year that aims to save the state an estimated $100 million over the next two years."There has to be fair reimbursement," said Hattab, who opened his pharmacy just south of Interstate 20 off Granbury Road in Fort Worth after working for the Walgreens and CVS pharmacy chains. "Most of the pharmacies rely on that fee" for the bulk of their compensation for Medicaid prescriptions, he said, and he predicted fewer pharmacies will be willing to fill those prescriptions under the lower payment.Charles Cote, a spokesman at the Pharmaceutical Care Management Association, said last week that Texas' Medicaid program "uses fewer generic drugs and three times the fee Medicare pays" pharmacies to fill a prescription. By adopting managed-care practices, "Texas will save hundreds of millions of dollars without cutting benefits to those in need," he said.The association represents pharmacy benefit managers, or PBMs, which are consultants that payers and insurers use to design prescription drug plans.Pharmacies are reimbursed for filling prescriptions in two ways: a flat-rate dispensing fee and a percentage of the cost of the drug.According to a recent study, Texas' dispensing fee under Medicaid was among the highest in the nation.But Marvin Shepherd, a professor of pharmacy at the University of Texas at Austin, told a legislative hearing last week that the reimbursements proposed by PBMs, "are very, very low." If a pharmacy only fills 20 Medicaid prescriptions a month, it can make up the shortfall, "but if it's 70 or 80 percent, you can't."Shepherd told a meeting of the House Public Health Committee on Tuesday that he calculates that it costs between $10.50 and $11 for a pharmacy to fill a prescription. While Texas' dispensing fee has been high compared with other states, pharmacists were paid less of the product cost.He said that even if a pharmacy participates in a strong buying group that negotiates lower wholesale prices on drugs, it won't come close to covering its costs under the new Medicaid reimbursements. He calculated the average payment from PBMs at between $5.36 and $6.95 for brand-name drugs, and $3 to $3.96 for generics.Committee members appeared sympathetic to those concerns, but offered no solutions barely a month before the changes take effect."It seems like a lack of transparency" in how the PBMs plan to pay pharmacies, said committee Chairwoman Lois Kolkhorst, R-Brenham. If reimbursements can't maintain a network of community pharmacists, which she described as valuable sources of information for consumers, "it's a problem," Kolkhorst said.Larry Cowan, owner of Glenview Professional Pharmacy in Richland Hills, said Medicaid is only about 10 percent of his business.But for pharmacies in poorer rural areas or regions like South Texas, "this could put them out of business," he said.He said the state's move to managed care is ill-considered.PBMs, he said, "made all these grandiose promises they could save millions of dollars. Their way to save money is to drastically reduce what they pay us to dispense prescriptions."Mark Merritt, president of the Pharmaceutical Care Management Association, said in a prepared statement that "voters would rather modernize Medicaid pharmacy than cut benefits for patients or payments to doctors and hospitals." Merritt said New Jersey and New York have enacted plans similar to Texas.But Hattab, the Fort Worth pharmacist, said "PBMs are cutting benefits, not healthcare costs."Texas' Medicaid drug program was working fine, he said."They have been fair. They're very prompt on payment. Most of the pharmacies rely on their fee to compensate for the squeeze in other payments," he said. "All this is going to go away. And that is the anxiety that pharmacies have."Jim Fuquay, 817-390-7552Twitter: @jimfuquayHave more to add? News tip? Tell us
