A proposed Medicaid rule that would lower pharmacy reimbursement levels for generics may just dampen enthusiasm for copycat meds. The Centers for Medicare and Medicaid must issue a final regulation July 1, and the change involves switching to average manufacturer price, instead of the average wholesale price.
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
2 Comments
As a pharmacy director for a medicaid managed care plan, I want to make the point that the institution of AMP does not necesarily mean you will see problems with pharmacy benefit managers and others who serve these type of beneficiaries. At this point in time, it can only be expected that AMP will be adapted in the medicaid fee-for-service population. Because it will be a federal requirement. There has been no indication that state medicaid agencies will then impose a trickle-down and require medicaid managed care plans (and their PBMs) to adopt the same. What you might see are pharmacies that are more willing to accept payment from managed care plans and their PBMs, rather than the state medicaid plans themselves. Something to ponder, anyway.
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