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Retail pharmacy operators continue to find themselves on the firing line as government officials work to rein in health care spending and address worrisome long-term budget deficits.
Medicaid, the federal/state program that provides health care for the indigent, is a case in point. Consider these recent developments:
• California officials obtained approval from the Department of Health and Human Services for a 10% reimbursement cut to many health care providers, including pharmacies, that serve such patients.
• A study by Kaiser Family Foundation found that almost every state is looking at ways to limit Medicaid expenditures to counter the loss of federal stimulus funds and the adverse effects of an anemic economy.
• Federal upper limits, or FULs, on reimbursements for medications dispensed under the program proposed by the Centers for Medicare and Medicaid Services would in many instances fall below retailers’ wholesale acquisition costs.
Add to those pressures looming cuts in Medicare and downward pressure on reimbursements in the private sector, and community pharmacy finds itself in a difficult spot. Fortunately, the profession has the wherewithal to mount a counteroffensive that should make the budget cutters sit up and take notice.
The case for pharmacy is laid out succinctly in recent testimony provided to a Senate Committee by the National Association of Chain Drug Stores, which pointed out that medication nonadherence costs the country $290 billion a year. By helping ensure patients use prescription drugs properly, the testimony stated, pharmacists maximize the benefit of drug therapy, and when that happens “it will reduce expenditures for higher-cost medical care, such as emergency room visits and catastrophic care.”
The data to back up that stance is mounting. The challenge for pharmacy advocates is to convince health care payers to look beyond the next fiscal year and consider the long-term contributions the profession can make to enhancing patient outcomes and limiting overall health care costs.
