State's pharmacy community cheers court action on Medicaid

Community pharmacy lawsuit moves to protect low-income patients’ access to medications Harrisburg — Calling it a victory for Pennsylvania’s low-income Medicaid patients, the state’s pharmacists are applauding a US District Court’s decision that will delay drastic reimbursement cuts for services performed by community pharmacies. On Dec. 14, the United States District Court for the District of Columbia on a preliminary injunction motion, put the brakes on efforts by the Centers for Medicare and Medicaid Services (CMS) to impose Medicaid pharmacy reimbursement reductions scheduled to be implemented next month, and hamper access for low-income patients’ to medications. More specifically, Judge Royce Lamberth ruled that CMS will not be permitted to post data on the Internet related to the average manufacturer prices (AMP) of generic pharmaceuticals. Nor will cuts to reimbursement for those generics take effect before Judge Lamberth has had an opportunity to fully review and make a final decision on the merits of the lawsuit. “This is not only an issue about ensuring due process for Pennsylvania’s community pharmacies, but more importantly, it’s an issue about assuring access to pharmacy services for the neediest patients in our communities,” said Janet Hart, RPh, president of PACDS. “In many instances, the federal government’s new policy would have resulted in pharmacies being reimbursed less than what they actually paid for the drug. No business can continue to operate if it provides products and services below its actual costs. Pharmacies are no different,” said PA Pharmacists Association Executive Director, Pat Epple. Stephen W. Schondelmeyer, Pharm.D., Ph.D., director of the PRIME Institute at the University of Minnesota, in a report submitted to the court as expert evidence provided dire warnings about the effects of the cuts. Dr. Schondelmeyer indicated the retail pharmacy industry could see a loss of 10,000 to12,000 pharmacies - a vast majority of which would be in rural or inner city urban areas - over the next few years. The potential loss of a large number of pharmacies nationwide would impact not only Medicaid patients, but all patients who rely on their pharmacies for prescription and health care services. “Without a doubt, the federal government’s Medicaid cuts would have disproportionately hurt low-income patients who may already have difficulty accessing their prescription medications, health care services and general health care information,” added Melanie Horvath, Executive Director of the PA Pharmacy Council. The National Association of Chain Drug Stores (NACDS) and the National Community Pharmacists Association (NCPA) filed a lawsuit against CMS and the U.S. Department of Health and Human Services, as well as, in their official capacities, Health and Human Services Secretary Michael O. Leavitt and CMS Acting Administrator Kerry Weems on November 7. Unless CMS appeals the preliminary injunction, the next step in the legal process will be a final ruling by Judge Lamberth on the merits of the lawsuit. Until that time, the AMP rule put forth by CMS will not take effect. Hart, Epple and Horvath said they were encouraged that the Court recognized that chain and community pharmacies would be greatly harmed if these reimbursement cuts moved forward. They said that PACDS, PPA and PPC remain vigilant in seeking a long-term solution and added that they would pursue state legislation if Congress or the courts don’t act soon.