Pharmacist Narender Dhallan winces as he looks at a computer screen in his drugstore on a recent morning. For the second time in two hours, he has to decide whether to fill a prescription and lose money or send his customer away.

This time it's for a generic antifungal cream that cost him $180 wholesale. The customer's insurance, however, will pay Dhallan only $60 to fill it.

"This used to be something that would happen once in a rare, rare while," Dhallan says. "Now it's becoming routine."

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.