BLOOMINGTON — Independent pharmacists worried that their days of filling prescriptions may be numbered because of recent Medicaid managed care changes are hoping for a state legislative solution in the fall.
A bill written to address their concerns was not approved in the final days of the Illinois General Assembly's spring legislative session.
But an appropriation designed to provide relief to small pharmacies was included in the state budget approved by the General Assembly and recently signed by the governor.
"This is going to be a long fight," Garth Reynolds, executive director of the Illinois Pharmacists Association, said this week.
In the meantime, at least one pharmacy in the region is closing due to the Medicaid issue.
Sav-Mor Pharmacy in Mount Zion announced on its Facebook page this week that it will close at the end of July after five years. The business said "today's reimbursement model to pharmacies demand a larger volume of prescriptions for survival in the marketplace."
Illinois has been transitioning to Medicaid managed care, meaning private insurers administer Medicaid benefits for the state. The program went statewide in April; one goal is to save the state money.
But Medicaid managed care organizations reimburse pharmacies for medications at lower rates than traditional Medicaid.
For example, Rob Taveggia, owner of Chenoa Pharmacy, told The Pantagraph in May that, previously when he would fill a prescription for someone on Medicaid, he would make $3 to $6 on each order. He said during one week in early April, he filled 210 prescriptions for people on Medicaid managed care, lost money on 35 of those prescriptions and made less than a dollar on 110 of them.
Lauren Young, business manager for Dale's Southlake Pharmacy and Colee's Community Pharmacy in Decatur and Colee's Corner Drugs in Forsyth, noted that the average dispensing fee they previously received for a Medicaid managed care patient was $6.77. Now it's 89 cents.
Part of the problem, independent pharmacists said, is that pharmacy benefit managers (PBMs), who are contracted by health plans, employers and governments to manage prescription drug programs, determine which pharmacists to include in drug plan networks, how much pharmacies are paid for services and which drugs are covered.
Illinois House Bill 3479 would require Illinois Medicaid managed care organizations to provide fair and reasonable reimbursement to pharmacies and require more transparency from PBMs. Independent pharmacists support the legislation.
"We have an issue here that needs government oversight to make sure taxpayers dollars are well spent," Reynolds said. "Our goal is to bring openness and accountability to the program without balancing the success of the program on the backs of the providers."
But the spring legislative session ended without a vote on the bill as legislators focused on passing a state budget, he said.
But the budget does include $10 million in relief for pharmacies that operate 10 or fewer locations and operate in communities of 50,000 or fewer people.
Reynolds hopes for passage of House Bill 3479 during the fall veto session.
Meanwhile, the situation for independent pharmacists remains "miserable," Taveggia said this week.
He hasn't heard whether he'll qualify for any of the budget "relief" earmarked for small pharmacies.
"I have no idea how they'll decide who qualifies and who doesn't," Taveggia said.