WASHINGTON — The Alliance for Patient Care (APC), a coalition of health care providers, including pharmacists, has gone to the nation’s capital to urge the Centers for Medicare & Medicaid Services (CMS) and Congress to reject proposed reductions to Medi-Cal, California’s Medicaid program.
APC members — including the National Association of Chain Drug Stores (NACDS), California Pharmacists Association (CPhA) and California Medical Association — plan to meet Thursday with Donald Berwick, CMS administrator; Cindy Mann, director of the center for Medicaid and state operations; and Congressional leaders.
In May, the APC sent a letter to Department of Health and Human Services (HHS) Secretary Kathleen Sebelius that called on CMS to strike down California’s plan to reduce reimbursements to health providers, including pharmacies, by 10% as part of overall cutbacks to Medi-Cal. The letter came in response to the passage of Assembly Bill 97, which has been signed by California Gov. Jerry Grown and needs CMS’ approval to take effect.
CMS had previously nixed a proposal to cut Medi-Cal reimbursements. According to APC, in 2008 a similar plan was submitted that called for reimbursement reductions for all Medi-Cal providers, but CMS ended up rejecting the plan last November.
"The California Pharmacists Association is deeply concerned that the state of California is again seeking to limit access to health care services for underserved Medicaid patients by significantly reducing provider payments and imposing mandatory co-payments on patients," CPhA chief executive officer Jon Roth said in a statement. "Patient access to affordable medication and pharmacist-delivered services ensures that both acute illnesses and chronic diseases are managed cost-effectively, thereby reducing hospital admissions and emergency room visits. The state of California has failed to acknowledge the long-term costs associated with the proposed cuts and is instead relying on short-term budget maneuvers."
APC noted that many health care providers can’t afford to participate in Medi-Cal because its rates are too low. The coalition reported that half of all doctors in California don’t participate in Medi-Cal, and as a result 56% of Medi-Cal patients report difficulty finding a physician. Also, APC said Kaiser State Health Facts lists California as the lowest reimbursed state in the nation.
Currently, Medi-Cal is the source of health care for one in five Californians, or about 7 million people, and the implementation of health care reform stands to add another 3 million uninsured individuals to the state program, according to APC.
"One of the most effective ways of controlling prescription drug costs is by increasing the utilization of generic medications," NACDS CEO Steve Anderson stated. "By implementing policies that increase generic utilization, such as prior authorization and step therapy, and by working with pharmacies and other health care providers to improve medication adherence and coordinate the care of Medicaid beneficiaries with chronic conditions, the Medi-Cal program could control Medicaid spending without threatening Medicaid beneficiaries’ access to healthcare services."
Last month, NACDS and the California Retailers Association submitted a letter to CMS urging the agency to reject California’s state plan amendment to cut Medi-Cal reimbursements to pharmacies and other health providers.
Also in July, a newly formed coalition of pharmacists, businesses and consumers — dubbed Pharmacy Choice and Access Now (PCAN) — called on HHS and CMS to deny the enactment of the proposed Medi-Cal cuts, saying the move would significantly reduce health care access in California. Medi-Cal payment rates are 20% lower than the national average Medicaid rates, and California ranks 47th out of 50 in provider payment rates, PCAN reported, citing figures from the California Academy of Family Physicians.
