Pharmacies Will Lose 36% on Medicaid Prescriptions, Report Says

Jan 26, 2007 3:00 AM

WASHINGTON -- Pharmacists will lose an average of 36% on every Medicaid prescription they fill, according to an analysis dated Dec. 22, 2006, and released publicly this week by the Government Accountability Office here. The analysis used the new formula for reimbursing pharmacies, 250% of the lowest Average Manufacturer‘s Price for the drugs, and was based on a sample of the most prescribed and highest-cost prescriptions used by Medicaid recipients. "In essence, CMS is forcing a pharmacy to accept payment that is 36% below its cost or stop participating in a program that provides prescriptions to our nation's poor," said Bruce Roberts, vice president and chief executive officer of the National Community Pharmacists Association, Alexandria, Va. In concluding its report to Congress, the GAO noted that "[Medicaid] savings should be achieved while ensuring that reimbursements to retail pharmacies are adequate." NCPA is currently working with Congress to redefine AMP so that it fully covers pharmacies' costs, and ensures Medicaid recipients' access to pharmacy services, the association said.