States across the country are looking to close budget gaps through these poorly conceived cuts to Medicaid. These cuts will hurt underserved populations by reducing their provider choices and limiting their access to prescriptions and other services.

Local community-based pharmacies allow for the most cost-effective delivery of everyday health services. Cuts to Medicaid pharmacy reimbursement will not only reduce choice and competition for Medicaid patients, but ultimately result in increased costs to the state and all of its citizens by patients using more expensive points of care.

These cuts will force quality health service providers from the marketplace, reducing competition and in turn the cost-effective delivery of pharmacy services to patients. Enacting ill-advised cuts at this time would hurt the most vulnerable populations who are served by Medicaid and cost states millions of additional scarce dollars.

Pharmacy Choice and Access Now is fighting to stop these cuts to Medicaid and protect patients’ access to provider choices, prescriptions and other services.


Your Health Your Local Pharmacy

Cuts in Medicaid reimbursement fees threaten the continued ability of local Pharmacies to provide the care you need.

The draconian cuts to Medicaid pharmacy reimbursements being proposed by some states will render continued provisions of pharmacy services infeasible for many neighborhood pharmacy providers, reducing access and further harming our fragile economy. Maintaining adequate reimbursement levels is absolutely necessary to maintain continuity of services you need.

Proposed cuts could lead to the shut-down of your local neighborhood pharmacy and cause Medicaid recipients to lose access to prescriptions drugs that they depend on daily to stay out of hospitals and emergency rooms.

More thoughtful, more cost-effective alternatives are available and should be fully considered. These well-conceived ideas, all designed to reduce costs, while at the same time maintaining quality of care, will more sustainably help states balance their budget, without putting your neighborhood pharmacy “out of business.” Medicaid managed care pharmacy “carve-in’s,” may look good on paper, but in practice often cause duplication of administrative effort and waste millions of tax dollars at a time when not a single dollar can afford to be wasted.

States such as Texas are rushing to judgment and considering a so-called “carve-in” of pharmacy services to Medicaid managed care. While the principles of managed care may, in theory, produce savings for the delivery of certain health services, the “carve-in” of pharmacy services would unjustly enrich costly middlemen that stand between patients and doctors and pharmacies. This ill-considered approach would cause the creation of duplicative, unnecessary bureaucracy within state health care agencies and cause overall Medicaid pharmacy costs to increase. For example, in February 2010, Ohio Medicaid carved out the pharmacy benefit previously controlled by a Medicaid managed care organization. This move is expected to save the state approximately $243 million dollars.


Who Is Impacted

With a need to balance budgets, lawmakers in some states are rushing to judgment and proposing to make ill-advised cuts to health services before fully considering the most cost effective solutions that can be made in the health services sector. The potential costs to taxpayers are being further increased by costly middlemen who are taking advantage of the budget crisis by strong-arming their way between you, and community pharmacy providers. As states consider moving Medicaid pharmacy benefits into managed care, the following policy recommendations should be adopted to ensure that Medicaid beneficiaries retain access to vital prescriptions at the lowest possible cost to the states.

  • Open Networks
  • No Mandatory Mail
  • 90-day Retail Fills
  • Prompt Pay
  • Pass-through Pricing
  •  Audits

All consumers who are serviced by state Medicaid programs for health care and pharmacy needs, anyone who shops at, or is employed by local pharmacies and every single taxpaying individual would be negatively impacted by legislation currently being considered or proposed in your state.