Independents voice concern about low generic payments

April 8, 2015

Inadequate reimbursement rates are threatening patient access to generic drugs and to community pharmacies, according to a recent survey by the National Community Pharmacists Association (NCPA).

Inadequate reimbursement rates are threatening patient access to generic drugs and to community pharmacies, according to a recent survey by the National Community Pharmacists Association (NCPA).

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NCPA surveyed 700 community pharmacists in March. Nearly all survey respondents reported a large increase in the acquisition costs of generics during the past six months.

“For decades community pharmacists have promoted the appropriate use of generic drugs to lower costs. However, more recently the price for some of these medications has skyrocketed 1,000% or more virtually overnight while reimbursement rates paid to community pharmacists have inexcusably lagged behind for weeks or months,” said NCPA CEO B. Douglas Hoey, RPh, MBA.

Hoey added: “This survey finds that this problem has only grown more severe over the past two years and requires urgent attention from federal and state policymakers.”

According to the survey:

· Nearly nine out of 10 pharmacists (87 percent) said it took one month or longer for reimbursement rates to be updated by the insurance plan’s pharmacy benefit manager (PBM) to reflect market costs.

 

· Ninety two percent said the problem of slow reimbursement updates has gotten worse since 2013 and that appeals to update reimbursement benchmarks are routinely denied or ignored by PBMs.

Click here to see and hear pharmacists describing problems with below-cost reimbursements.

“Community pharmacies cannot be expected to continually fill many prescriptions at a significant loss. Ultimately patients are impacted as well. Some patients are already skipping medication due to higher prices and copays or are forced into the Medicare coverage gap or ‘donut hole’ sooner,” Hoey said. “Others will likely find it more difficult to find certain generic drugs at all because their pharmacy can no longer afford to stock and dispense them.”

Reps. Doug Collins (R-Ga.) and Dave Loebsack (D-Iowa) have introduced legislation that would require reimbursement benchmarks be updated every seven days. The law would apply to Medicare Part D, the military’s TRICARE program, and the Federal Employees Health Benefits Program.

See also:

Pharmacies lose Medi-Cal reimbursement appeal