NCPA offers input for CMS Medicaid Access Rule

July 12, 2011

While the National Community Pharmacists Association (NCPA) is in favor of the Medicaid Access Rule proposed by the Centers for Medicare and Medicaid Services (CMS), it has several concerns about the proposal.

While the National Community Pharmacists Association (NCPA) is in favor of the Medicaid Access Rule proposed by the Centers for Medicare and Medicaid Services (CMS), it has several concerns about the proposal.

The Access Rule seeks to create a standardized process for states to follow, to ensure that Medicaid rates are consistent with “efficiency, economy, and quality of care.” The rule is necessary to prevent arbitrary state cuts to Medicaid provider reimbursement when an analysis of the effects of the cuts has not been made, said NCPA.

However, CMS needs to change or clarify several parts of the rule. For example, in order to adequately calculate pharmacies’ reimbursement rates, states should conduct cost-of-dispensing studies. “If Medicaid pharmacy reimbursement rates are so low that pharmacists would not simply be underpaid but would in fact lose money on Medicaid prescriptions, it will be extremely difficult to retain pharmacists willing to participate in the program,” wrote John Coster, PhD, RPh, senior vice president of government affairs for NCPA and director of NCPA’s Advocacy Center, in a recent letter to CMS.

NCPA is also urging CMS to consider the tangible benefits of patients’ interaction with pharmacists, after the agency proposed use of mail-order pharmacies as a potential cost-savings strategy. “There have been no published peer-reviewed studies that indicate that prescriptions purchased through mail-order pharmacies are less expensive than those purchased at retail pharmacies,” Coster wrote.

In addition, mail-order pharmacies are not necessarily appropriate for the Medicaid population, since community pharmacies represent the most accessible point in patient-centered healthcare, according to Coster.“This access and related counseling is especially relevant with regard to the Medicaid population, in which many recipients deal with more than one chronic medical condition,” Coster wrote.