As a practical matter, the HHS Office of Inspector General just released a report showing pharmacies typically paid just 4 cents for each tablet of lorazepam, a widely prescribed sedative, but were remibursed 57 cents - a huge margin, yes? Under the new rule, reimbursement would fall to 3.3 cents, which amounts to a 21 percent loss on each tablet. At that rate, pharmacists can be expected to say they'll need a sedative.
This has widespread implications, because pharmacies are threatening to drop Medicaid patients. And that won't be good for generic drugmakers or pharmacy benefit managers, which push generics over costlier brand-name meds. Adam Fein, a consultant who opines on DrugChannels, wonders whether this will tilt the balance back toward big pharma. He could be right.
Imagine - the nation's poorest customers one day soon visiting their pharmacy and walking out with medications associated with some of the highest prices imaginable. Or maybe some won't get any med.
Hat tip to Drug Channels