NCPA, NACDS explain importance of pharmacies in Medicaid program

The National Association of Chain Drug Stores (NACDS) and the National Community Pharmacists Association (NCPA) have sent a joint letter to every Governor and State Medicaid Director, explaining the importance of pharmacies in Medicaid, offering recommendations, and expressing a desire to work together to cut costs without endangering Medicaid beneficiaries' access to pharmacy prescription drug services.  

"Community pharmacies play a vital role in the Medicaid program as the backbone of its drug benefit," NACDS President and CEO Steven C. Anderson, IOM, CAE and NCPA Executive Vice President and CEO Kathleen Jaeger wrote in the letter. "Local pharmacists can provide expert medication counseling and other cost-saving services that help mitigate the $290 billion that is estimated to be spent on an annual basis as the result of patients who do not adhere properly to their medication regimen.

"Every day, community pharmacies witness firsthand the struggles that patients face in order to pay for their medications as well as the financial burden states face in attempting to provide for the needs of their Medicaid beneficiaries," they added.  "Community pharmacies are ready and willing to work collaboratively with CMS, individual states and other payers to help reduce health costs."

The recommendations include:

• Community pharmacies are leading the way to maximize generic drugs' appropriate use.  Community pharmacy has a higher rate of generic dispensing (71%) than any other practice setting, including mail order pharmacy.  The Massachusetts fee-for-service Medicaid program has a generic dispensing rate of 79.3%, a rate which could save $5.14 billion if achieved nationally.
• Retain prescription drug coverage as a vital component to state Medicaid programs, as any savings from severing access to prescription medications are likely to be eclipsed by costly downstream medical interventions to control a variety of life-threatening conditions.
• The community pharmacist can provide critical advice and guidance to patients with chronic conditions, who very often need instruction and re-enforcement of optimal medication use. Incorporating medication therapy management (MTM) services provided by pharmacists will help lead to increased savings. 
• For states considering adjustments to beneficiary cost sharing, we urge them to make these co-payments mandatory as permitted under federal law.  Requiring pharmacies to bear the costs of uncollected co-payments – which in some states is as high as 50% - is unfair, particularly at a time when there have already been significant reductions in pharmacy Medicaid reimbursement.  
• States considering an average acquisition cost (AAC)-based pharmacy reimbursement formula should conduct comprehensive cost-of-dispensing studies and adjust state dispensing fees, recognizing the importance of reimbursing pharmacies accurately for all aspects of providing prescriptions to Medicaid patients.