Area pharmacies express optimism after Senate passes Medicaid reimbursement bills

March 03--Officials with independent pharmacies in Owensboro and McLean County expressed optimism Friday after the Kentucky Senate passed a bill that would give the state the power to determine how much pharmacies are reimbursed from Medicaid for drug sales.

Senate Bill 5 passed the full Senate on Thursday on a vote of 32-4. The bill would place Medicaid reimbursement with the state Department of Medicaid Services, taking that authority away from pharmacy benefit managers.

Pharmacy benefit managers connected to large corporations such as CVS Caremark have hurt independent pharmacies, supporters of SB 5 say, by reimbursing small pharmacies at a rate so low that the pharmacies actually lose money serving Medicaid patients.

With the bill's passage in the Senate, it now moves to the House.

Luke Shockley, manager of Owensboro Family Pharmacy, said a demonstration of pharmacists is planned for Wednesday in Frankfort in support of the bill.

Allowing PBMs connected to large pharmacy corporations such as CVS set Medicaid reimbursement for independent pharmacies has hurt the Owensboro pharmacy, Shockley said.

"We've had to be creative in coming up with ways to deal with those losses," Shockley said.

The pharmacy loses money serving Medicaid patients, but the pharmacy doesn't turn them away because that would result in a delay in them receiving their prescriptions, Shockley said.

"We know these people on a first name basis," Shockley said. "Sometimes, we have to take a loss."

Of the practice of letting PBMs setting reimbursement for small pharmacies, Shockley said, "no other industry (lets) their direct competition decide how much they get paid."

Dr. Gregg Henry, the owner of Sacramento Pharmacy, said he was encouraged SB 5 passed the Senate by such a large margin.

"I'm extremely optimistic," Henry said.

He said he was also pleased that, earlier in the week, a House committee approved House Bill 463, which would allow pharmacists to tell customers if the cost of their medication would be lower if they paid in cash rather than if they pay through their health insurance or Medicaid. The House bill would also block PBMs from setting insurance co-pays higher than the actual cost of the medication.

Because the House is already working on HB 463, "the are already somewhat educated on the issues we are having with PBMs," Henry said. "... I don't think we are going to have to be starting from scratch in the House."

The full House will next have to pass HB 463 for the bill to move on. Bills have to pass both chambers and be signed by the governor to become law.

If the House bill makes it to the Senate, "they are going to say, 'this is another aspect of the same issue, which is the lack of oversight'" of how state Medicaid dollars are spent.

Shockley said supporters of SB 2 have been active.

"We even got a (list) of what senators voted no, what senators were absent and who to call and thank for voting yes," Shockley said.

James Mayse, 270-691-7303, [email protected], Twitter: @JamesMayse

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