New Rule Continues Medicaid Burden on Independent Pharmacists

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A recent decision by a statewide Medicaid operator has independent pharmacists upset again

Back in January, it was a group of pharmacists who blew the door off the hinges when it comes to problems with Kentucky'’s Medicaid managed care system.

Then, they were angry over a lack of co-pays on drugs. Now, operator Coventry Cares has reversed course, claiming it will now charge co-pays.

But in doing so, Kentucky pharmacist Jason Wallace says the MCO's are just moving money around, not actually compensating pharmacists any better than before.

“This is hardly a win because what they simply will do is deduct it from what they pay us,” he says.

Wallace says the operator will now eliminate a $1 additional dispensing fee in order to make up for letting pharmacists collect co-pays.

“"I know we’'re talking about a dollar here, but when you’'re talking about the cost of dispensing a drug in the 10 to 11 dollar territory and we'’re being reimbursed somewhere around a dollar in terms of a dispensing fee, that extra dollar that we were talking about in House Bill 262, makes a big difference,"” Wallace says.

Wallace says with the defeat of that House bill, he and his fellow pharmacists are unsure of what their next direction is.